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Anudeep DDS, Karthik K, Holla VV, Kamble N, Yadav R, Pal PK, Mahale RR. Ventrolateral medullary compression by vascular contact in primary hemifacial spasm: a radiological analysis. Neurol Sci 2024; 45:4857-4861. [PMID: 38789836 DOI: 10.1007/s10072-024-07602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The neurovascular conflict (NVC) causing hemifacial spasm (HFS) can also cause compression of ventrolateral medulla (VLM) which contains the central sympathetic neurons. VLM compression has been associated with hypertension. Whether the VLM compression in HFS patients is associated with hypertension is not clear. OBJECTIVE To determine the frequency, severity of VLM compression and its association with hypertension in HFS patients. METHODS A cross-sectional, hospital-based, case control study and recruited 120 study subjects (50 cases of primary HFS, 30 hypertensive and 40 normotensive age-, sex- matched controls). The VLM compression was assessed in magnetic resonance imaging Constructive Interference in Steady State (CISS) 3D sequences. RESULTS Hypertension was present in 30 cases (60%). Six patients with HFS (20%) were detected to be hypertensive after the onset of HFS. VLM compression was seen in 24 cases (48%), 7 hypertensive controls (23.3%) and 5 normotensive controls (10%) (p = 0.03). Twenty-four patients with hypertension had VLM compression and remaining 6 patients with hypertension did not have VLM compression (80% vs 20%; p = 0.02). Normotensive patients did not have VLM compression. Vertebral artery was the most common artery causing VLM compression (22 patients; 7 hypertensive and 5 normotensive controls). CONCLUSION VLM compression is more common in HFS patients as compared to hypertensive and normotensive controls. It is more common in hypertensive HFS patients in comparison with normotensive HFS patients. Microvascular decompression is an option in hypertensive HFS patients with VLM compression if the hypertension is medically refractory.
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Affiliation(s)
- D D S Anudeep
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - K Karthik
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Rohan R Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India.
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Zeng D, Wang S, Wei X, Zhang S, Zhou H, Hu X, Fu X, Li Y, Wei Z. The effect of microvascular decompression of the CN IX-X root entry/exit zone and the ventrolateral medulla in neurogenic hypertension involving the vertebral/basilar artery. Front Neurol 2024; 15:1376019. [PMID: 38957353 PMCID: PMC11218759 DOI: 10.3389/fneur.2024.1376019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/23/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Neurogenic hypertension (HTN) is a type of HTN characterized by increased activity of the sympathetic nervous system. Vascular compression is one of the pathogenic mechanisms of neurogenic HTN. Despite Jannetta's solid anatomical and physiological arguments in favor of neurogenic HTN in the 1970's, the treatment for essential HTN by microvascular decompression (MVD) still lacks established selection criteria. Therefore, the subjects selected for our center were limited to patients with primary trigeminal neuralgia (TN) and primary hemifacial spasm (HFS) of the vertebral/basilar artery (VA/BA) responsible vessel type coexisting with neurogenic HTN who underwent MVD of the brainstem to further explore possible indications for MVD in the treatment of neurogenic HTN. Methods A retrospective analysis of 63 patients who were diagnosed with neurogenic HTN had symptoms of HFS and TN cranial nerve disease. Patients were treated at our neurosurgery department from January 2018 to January 2023. A preoperative magnetic resonance examination of the patients revealed the presence of abnormally located vascular compression in the rostral ventrolateral medulla (RVLM) and the root entry zone (REZ) of the IX and X cranial nerves (CN IX- X). Results There was no significant difference between the two groups in terms of gender, age, course of HFS, course of TN, course of HTN, degree of HTN, or preoperative blood pressure. Based on the postoperative blood pressure levels, nine out of 63 patients were cured (14.28%), eight cases (12.70%) showed a marked effect, 16 cases (25.40%) were effective, and 30 cases were invalid (47.62%). The overall efficacy was 52.38%. However, 39 cases of combined cranial nerve disease were on the left side of the efficacy rate (66.67%) and 24 cases of combined cranial nerve disease were on the right side of the efficacy rate (29.16%). Discussion Over the last few decades, many scholars have made pioneering progress in the clinical retrospective study of MVD for neurogenic hypertension, and our study confirms the efficacy of MVD in treating vertebral/basilar artery-type neurogenic hypertension by relieving the vascular pressure of RVLM. In the future, with the development and deepening of pathological mechanisms and clinical observational studies, MVD may become an important treatment for neurogenic hypertension by strictly grasping the surgical indications. Conclusion MVD is an effective treatment for neurogenic HTN. Indications may include the following: left-sided TN or HFS combined with neurogenic HTN; VA/BA compression in the left RVLM and REZ areas on MRI; and blood pressure in these patients cannot be effectively controlled by drugs.
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Affiliation(s)
- Defeng Zeng
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Graduate School, Dalian Medical University, Dalian, China
| | - Shiyao Wang
- Department of Graduate School, Dalian Medical University, Dalian, China
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xingrong Wei
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Graduate School, Dalian Medical University, Dalian, China
| | - Shuguang Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hao Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Graduate School, Dalian Medical University, Dalian, China
| | - Xueqian Hu
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Graduate School, Dalian Medical University, Dalian, China
| | - Xin Fu
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yang Li
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhenqing Wei
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Giammattei L, Wuerzner G, Theiler K, Vollenweider P, Dunet V, Al Barajraji M, Squair JW, Bloch J, Daniel RT. Lateral medullary vascular compression manifesting as paroxysmal hypertension. Acta Neurochir (Wien) 2024; 166:139. [PMID: 38488893 PMCID: PMC10943153 DOI: 10.1007/s00701-024-06032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
Neurovascular compression of the rostral ventrolateral medulla (RVLM) has been described as a possible cause of refractory essential hypertension. We present the case of a patient affected by episodes of severe paroxysmal hypertension, some episodes associated with vago-glossopharyngeal neuralgia. Classical secondary forms of hypertension were excluded. Imaging revealed a neurovascular conflict between the posterior inferior cerebellar artery (PICA) and the ventrolateral medulla at the level of the root entry zone of the ninth and tenth cranial nerves (CN IX-X REZ). A MVD of a conflict between the PICA and the RVLM and adjacent CN IX-X REZ was performed, resulting in reduction of the frequency and severity of the episodes. Brain MRI should be performed in cases of paroxysmal hypertension. MVD can be considered in selected patients.
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Affiliation(s)
- L Giammattei
- Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland.
| | - G Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - K Theiler
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - P Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - V Dunet
- Department of Medical Radiology, Service of Diagnostic and Interventional Radiology, Neuroradiology Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Al Barajraji
- Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland
| | - J W Squair
- Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland
| | - J Bloch
- Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore), CHUV/UNIL/EPFL, 1005, Lausanne, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospitzal (CHUV) and University of Lausanne (UNIL), 1005, Lausanne, Switzerland
| | - R T Daniel
- Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland
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Bozkurt G, Mammadkhanli O, Ozden M. Posterior Reversible Encephalopathy Syndrome Developing after Aggressive Posterior Fossa Tumor Surgery. Asian J Neurosurg 2022; 17:511-514. [DOI: 10.1055/s-0042-1757219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AbstractPosterior reversible encephalopathy syndrome (PRES) is a rare neurologic disorder, having such common radiological findings as vasogenic edema and white matter changes in watershed areas. The clinic and radiological outcome may not be reversible in 10 to 20% of patients, like in the case of our patient. Here, we discuss the pathogenetic factors that are essential in developing PRES after posterior fossa surgery. A 4-year-old female was admitted to our clinic with a recurrent/residual mass in the posterior fossa. She previously underwent posterior fossa surgery three times (for what was diagnosed as anaplastic astrocytoma through pathohistology) in another center. She was operated thrice in 5 days, and the tumor radically removed. Two days later, after the last surgery, while waking up, our patient developed seizures and altered consciousness. Her neurological condition was severe. Magnetic resonance imaging findings were compatible with those of PRES. Our patient had multiple risk factors for PRES that were as follows: multiple posterior fossa surgeries, anamnesis of chemotherapy and radiotherapy, high-dose steroid use, intracranial pressure changes, and hypertensive attacks due to surgical manipulation. In preventing the development of PRES, we should beware of sudden changes in blood pressure during surgery and meticulously manipulate the brain stem to avoid any disturbance of the central nervous system homeostasis. PRES may transform into real encephalopathy. If the patient has some of these risk factors, PRES would probably develop after surgery.
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Affiliation(s)
- Gokhan Bozkurt
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Orkhan Mammadkhanli
- Faculty of Medicine, Medical Park Ankara Hospital, Yuksek Ihtisas University, Ankara, Turkey
| | - Mahmut Ozden
- Department of Neurosurgery, Memorial Bahcelievler Hospital, Istanbul, Turkey
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5
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Wei X, Wang J, Kong X, Gao C, Wang F. Effect of Microvascular Decompression of the Vagus Root Entry/Exit Zone on Blood Pressure in Patients with Hemifacial Spasm Associated with Essential Hypertension: A Retrospective Clinical Analysis. J Neurol Surg B Skull Base 2022; 83:e336-e342. [PMID: 35833003 DOI: 10.1055/s-0041-1729178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/27/2021] [Indexed: 10/17/2022] Open
Abstract
Background This study aimed to evaluate blood pressure alterations after microvascular decompression (MVD) surgery in patients with hemifacial spasm (HFS) with coexisting hypertension (HTN). Methods A total of 56 patients with HFS with concurrent HTN who underwent MVD surgery in our center between 2015 and 2019 were retrospectively analyzed. Patients were divided into control and experimental groups: patients who received MVD treatment for only the facial nerve and those who received MVD for the affected facial nerve, ipsilateral vagus nerve, and adjacent ventrolateral medulla, respectively. Preoperative (3 days) and postoperative (7 days and 6 months) blood pressure measurements were analyzed. Results No statistically significant differences were observed in gender, age, HFS course, HTN course, HTN grade, and preoperative blood pressure between the two groups. No significant difference was observed between pre- and postoperative blood pressure in the control group. In the experimental group, systolic blood pressure significantly differed between 3 preoperative days and 7 postoperative days ( p < 0.05), as did diastolic blood pressure ( p < 0.05). Measurement at 6 postoperative months also showed significant differences for both systolic blood pressure and diastolic blood pressure compared with that at 3 preoperative days ( p < 0.05). HTN grade according to the World Health Organization classification criteria significantly differed between preoperative and postoperative measurements ( p < 0.05). Conclusion Vascular decompression of the ipsilateral vagus nerve roots may improve blood pressure management in patients with HFS with coexisting HTN who undergo MVD. Laterality of involvement (left vs. right) did not significantly differ.
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Affiliation(s)
- Xuefeng Wei
- Department of Neurosurgery, Ningxia Medical University, Yinchuan, China
| | - Jiao Wang
- Blood Purification Center, Wuxi No. 2 People's Hospital, Wuxi, China
| | - Xuerui Kong
- Department of Neurosurgery, Ningxia Medical University, Yinchuan, China
| | - Caibin Gao
- Department of Neurosurgery, General Hospital of Ning Xia Medical University, Yinchuan, China
| | - Feng Wang
- Department of Neurosurgery, General Hospital of Ning Xia Medical University, Yinchuan, China.,Ningxia Key Laboratory of Cerebrocranial Diseases, Yinchuan, China
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Microvascular decompression: a bibliometric analysis of the 100 most cited papers. World Neurosurg 2022; 164:e67-e81. [DOI: 10.1016/j.wneu.2022.03.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
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7
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Manava P, Hastreiter P, Schmieder RE, Jung S, Fahlbusch R, Dörfler A, Lell MM, Buchfelder M, Naraghi R. Neurovascular Compression in Arterial Hypertension: Correlation of Clinical Data to 3D-Visualizations of MRI-Findings. Open Neuroimag J 2021. [DOI: 10.2174/1874440002114010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims:
In this study, we attempted to identify clinical parameters predicting the absence or presence of Neurovascular Compression (NVC) at the Ventrolateral Medulla (VLM) in arterial hypertension (HTN) in MRI findings.
Background:
Cardiovascular and pulmonary afferences are transmitted through the left vagus and glossopharyngeal nerve to the brain stem and vasoactive centers. Evidence supports the association between HTN and NVC at the left VLM. Several independent studies indicate a reduction of HTN after Microvascular Decompression (MVD) of the left. Several independent studies indicate a reduction of HTN after Microvascular Decompression (MVD) of the left VLM. Image processing of MRI provides comprehensible detection of NVC. HTN affects hemodynamic parameters and organs.
Objective:
This study analyzes and correlates clinical data and MRI findings in patients with and without NVC at the VLM in treatment resistant HTN to obtain possible selection criteria for neurogenic hypertension.
Methods:
In 44 patients with treatment resistant HTN, we compared MRI findings of neurovascular imaging to demographic, clinical and lifestyle data, office and 24-hour ambulatory Blood Pressure (BP), and cardiovascular imaging and parameters.
Results:
Twenty-nine (66%) patients had evidence of NVC at the VLM in MRI. Sixteen patients (36%) had unilateral NVC on the left side, 7 (16%) unilateral right and 6 (14%) bilateral NVC. Fifteen (34%) had no evidence of NVC at the VLM. Patients with left sided NVC were significantly younger, than those without NVC (p=0.034). They showed a statistically significant variance in daytime (p=0.020) and nighttime diastolic BP (p<0.001) as the mean arterial pressure (p=0.020). Other measured parameters did not show significant differences between the two groups.
Conclusion:
We suggest to examine young adults with treatment resistant HTN for the presence of NVC at VLM, before signs of permanent organ damage appear. Clinical and hemodynamic parameters did not emerge as selection criteria to predict NVC. MVD as a surgical treatment of NVC in HTN is not routine yet as a surgical treatment of NVC in HTN is not routine yet. Detection of NVC by imaging and image processing remains the only criteria to suggest MVD, which should be indicated on an individual decision.
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Christophides T, Somaschini A, Demarchi A, Cornara S, Androulaki M, Androulakis E. New Drugs and Interventional Strategies for the Management of Hypertension. Curr Pharm Des 2021; 27:1396-1406. [PMID: 33155904 DOI: 10.2174/1381612826666201106091527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022]
Abstract
Essential hypertension is an important cause of cardiovascular morbidity and mortality worldwide with significant clinical and economic implications. The field of antihypertensive treatment already numbers numerous agents and classes of drugs. However, patients are still developing uncontrolled hypertension. Hence there is a continuous need for novel agents with good tolerability. Advances in this field are focusing both on pharmacotherapy, with the developments in traditional and non-traditional targets, as well as interventional techniques such as renal denervation and baroreflex activation therapy. It is likely that future strategies may involve a tailored approach to the individual patient, with genetic modulation playing a key role.
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Hamasaki T, Yamakawa T, Fujiwara K, Harashima H, Nakamura K, Ikuta Y, Yamamoto T, Hasegawa Y, Takezaki T, Mukasa A. Sympathetic hyperactivity, hypertension, and tachycardia induced by stimulation of the ponto-medullary junction in humans. Clin Neurophysiol 2021; 132:1264-1273. [PMID: 33867252 DOI: 10.1016/j.clinph.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/01/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate changes in autonomic activities and systemic circulation generated by surgical manipulation or electrical stimulation to the human brain stem. METHODS We constructed a system that simultaneously recorded microsurgical field videos and heart rate variability (HRV) that represent autonomic activities. In 20 brain stem surgeries recorded, HRV features and sites of surgical manipulation were analyzed in 19 hypertensive epochs, defined as the periods with transient increases in the blood pressure. We analyzed the period during electrical stimulation to the ponto-medullary junction, performed for the purpose of monitoring a cranial nerve function. RESULTS In the hypertensive epoch, HRV analysis showed that sympathetic activity predominated over the parasympathetic activity. The hypertensive epoch was more associated with surgical manipulation of the area in the caudal pons or the rostral medulla oblongata compared to controls. During the period of electrical stimulation, there were significant increases in blood pressures and heart rates, accompanied by sympathetic overdrive. CONCLUSIONS Our results provide physiological evidence that there is an important autonomic center located adjacent to the ponto-medullary junction. SIGNIFICANCE A large study would reveal a candidate target of neuromodulation for disorders with autonomic imbalances such as drug-resistant hypertension.
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Affiliation(s)
- Tadashi Hamasaki
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Toshitaka Yamakawa
- Priority Organization for Innovation and Excellence, Kumamoto University, 2-39-1 Kurokami, Chuo-ku, Kumamoto 860-0862, Japan
| | - Koichi Fujiwara
- Department of Material Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, Aichi 464-8601, Japan
| | - Haruki Harashima
- Priority Organization for Innovation and Excellence, Kumamoto University, 2-39-1 Kurokami, Chuo-ku, Kumamoto 860-0862, Japan
| | - Kota Nakamura
- Priority Organization for Innovation and Excellence, Kumamoto University, 2-39-1 Kurokami, Chuo-ku, Kumamoto 860-0862, Japan
| | - Yoshihiro Ikuta
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Tatsuo Yamamoto
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yu Hasegawa
- Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, 1-7-4 Momochihama, Sawara-ku, Fukuoka 814-0001, Japan
| | - Tatsuya Takezaki
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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Dodo Y, Takahashi T, Honjo K, Kitamura N, Maruyama H. Measurement of the length of vertebrobasilar arteries: A three-dimensional approach. J Neurol Sci 2020; 414:116818. [DOI: 10.1016/j.jns.2020.116818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/11/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
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11
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Manava P, Naraghi R, Schmieder R, Fahlbusch R, Doerfler A, Lell MM, Buchfelder M, Hastreiter P. 3D-Visualization of Neurovascular Compression at the Ventrolateral Medulla in Patients with Arterial Hypertension. Clin Neuroradiol 2020; 31:335-345. [PMID: 32462236 PMCID: PMC8211615 DOI: 10.1007/s00062-020-00916-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/12/2020] [Indexed: 11/04/2022]
Abstract
Purpose Controversy exists on the association of arterial hypertension (HTN) and neurovascular compression (NVC) at the ventrolateral medulla (VLM). No standardized and reproducible technique has been introduced yet for detection of NVC in HTN. This study aimed to generate, analyze and compare different results of exact reproducible anatomical 3D-representations of the VLM in patients with HTN, based on magnetic resonance imaging (MRI). Methods A 3T scanner provided MRI (T2-constructive interference in steady state (CISS) high resolution imaging and three-dimensional Time-of-flight (3D-TOF) angiography) from the posterior fossa of 44 patients with clinical treatment-resistant HTN. Image processing consists of segmentation of the CISS data, registration and fusion of the CISS and TOF data and visualization. For each patient two 3D-visualizations (before and after fusion) were obtained. The reproduction quality of the vessels, flow-related signal variability and pulsation artifacts were analyzed and compared, using a ranking score. Results Integrating vascular information from TOF into CISS data reduced artifacts in 3D-visualizations of exclusively processed CISS data. The quality of 3D-visualization of the vessels near the brain stem was significantly improved (p = 0.004). The results were reproducible and reliable. The quality of the 3D-presentations of neurovascular relationships at the VLM improved significantly (p < 0.001). Conclusion The 3D-visualization of fused image data provides an excellent overview of the relationship between cranial nerves and vessels at the VLM and simplifies the detection of NVC in HTN. It provides a powerful tool for future clinical and scientific research. Although microvascular decompression (MVD) in treatment resistant HTN is not a standard procedure, it can be discussed in selected patients with intractable severe HTN.
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Affiliation(s)
- Panagiota Manava
- Department of Neurosurgery, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Erlangen, Germany. .,Department of Radiology and Nuclear Medicine, Paracelsus Medical University, Nuremberg, Germany.
| | - Ramin Naraghi
- Department of Neurosurgery, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Erlangen, Germany.,Department of Neurosurgery, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Roland Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Rudolf Fahlbusch
- Department of Neurosurgery, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Erlangen, Germany.,International Neuroscience Institute, Hannover, Germany
| | - Arnd Doerfler
- Division of Neuroradiology, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Michael M Lell
- Department of Radiology and Nuclear Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Peter Hastreiter
- Department of Neurosurgery, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Erlangen, Germany
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12
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Efficacy of microvascular decompression on the vascular compression type of neurogenic hypertension: A meta-analysis. Rev Neurol (Paris) 2020; 176:763-769. [PMID: 32169328 DOI: 10.1016/j.neurol.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Neurogenic hypertension is a type of hypertension characterized by increased sympathetic activity. Vascular compression is one of the pathogenic mechanisms of neurogenic hypertension. The sample sizes of currently available studies on MVD in the treatment of hypertension are small, and the results are considerably different. Therefore, we conducted a meta-analysis of the previous literature to obtain the most realistic efficiency and analyzed the current situation of MVD as a treatment option of the vascular compression type of neurogenic hypertension. METHOD We systematically searched and identified relevant studies published before July 2019 from PubMed and Embase. Six studies involving 162 participants were included into our final analysis. RESULT The data showed that the effective rate of MVD was 70.1% (95% CI: 0.602-0.801). The most common offending vessel was PICA (29.9%), followed by VA/BA (23.9%) and VA/BA plus PICA (12.7%). Complications were mostly related to the VII, VIII, IX, and/or X cranial nerve dysfunction. CONCLUSION MVD as a treatment option of the vascular compression type of neurogenic hypertension is effective and safe. In spite of this conclusion, more prospective studies are needed to confirm it. On the other hand, a diagnostic method with higher sensitivity and specificity is necessary.
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13
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Microvascular decompression for the treatment of neurogenic hypertension with trigeminal neuralgia. BMC Neurol 2019; 19:341. [PMID: 31881866 PMCID: PMC6933738 DOI: 10.1186/s12883-019-1569-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/11/2019] [Indexed: 12/29/2022] Open
Abstract
Background To evaluate the efficacy of microvascular decompression (MVD) in reducing hypertension (HTN) in hypertensive patients with trigeminal neuralgia (TN). Methods The clinical data of 58 cases of neurogenic HTN with TN treated in our hospital were retrospectively reviewed. Preoperative MR revealed abnormal blood pressure in the left rostral ventrolateral medulla (RVLM) and the posterior cranial nerve root entry zone (REZ). The patients were divided into control group: only trigeminal nerve was treated with MVD; experimental group: trigeminal nerve, RVLM and REZ were treated with MVD at the same time. The patients were followed up for 6 months to 1 year to observe the changes of blood pressure. Results There was no significant difference in gender, age, course of TN, course of HTN, grade of HTN and preoperative blood pressure between the two groups. After operation, the effective rate of HTN improvement with MVD was 32.1% in the control group. There was no significant difference in the preoperative and post operative blood pressure. (P△SBP = 0.131; P△BDP = 0.078). In the experimental group, the effective rate was 83.3%. The postoperative blood pressure was significantly lower than preoperative values. (P△SBP < 0.001; P△DBP < 0.001). Conclusions MVD is an effective treatment for neurogenic HTN. However, the criteria for selecting hypertensive patients who need MVD to control their HTN still needs to be further determined. Possible indications may include: left trigeminal neuralgia, neurogenic HTN; abnormal blood pressure compression in the left RVLM and REZ areas on MR; and blood pressure in these patients can not be effectively controlled by drugs.
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Guyenet PG, Stornetta RL, Holloway BB, Souza GMPR, Abbott SBG. Rostral Ventrolateral Medulla and Hypertension. Hypertension 2019; 72:559-566. [PMID: 30354763 DOI: 10.1161/hypertensionaha.118.10921] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Patrice G Guyenet
- From the Department of Pharmacology, University of Virginia, Charlottesville
| | - Ruth L Stornetta
- From the Department of Pharmacology, University of Virginia, Charlottesville
| | - Benjamin B Holloway
- From the Department of Pharmacology, University of Virginia, Charlottesville
| | - George M P R Souza
- From the Department of Pharmacology, University of Virginia, Charlottesville
| | - Stephen B G Abbott
- From the Department of Pharmacology, University of Virginia, Charlottesville
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15
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Honey CM, Kaufmann AM. Trigeminal Neuralgia due to Vertebrobasilar Artery Compression. World Neurosurg 2018; 118:e155-e160. [DOI: 10.1016/j.wneu.2018.06.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 01/03/2023]
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16
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Cavallo C, Safavi-Abbasi S, Kalani MYS, Gandhi S, Sun H, Oppenlander ME, Zabramski JM, Nakaji P, Lawton MT, Spetzler RF. Pulmonary Complications After Spontaneous Aneurysmal Subarachnoid Hemorrhage: Experience from Barrow Neurological Institute. World Neurosurg 2018; 119:e366-e373. [PMID: 30075258 DOI: 10.1016/j.wneu.2018.07.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Because the clinical course of spontaneous aneurysmal subarachnoid hemorrhage (aSAH) can be compromised by pulmonary complications, we sought to review posttreatment outcomes in aSAH patients with and without pulmonary complications. METHODS Patient demographic, clinical, and outcome data (March 2003-January 2007) were analyzed retrospectively. Patients underwent microsurgical or endovascular treatment for aSAH; pulmonary complications were reported. Outcomes were assessed using the Glasgow Outcome Scale (GOS) scores at the 1-year, 3-year, and 6-year follow-up visits. RESULTS The cohort comprised 471 patients (mean age, 53.7 ± 12.4 years; men, 332/471 [70%]). The mean Glasgow Coma Scale (GCS) score at presentation was 11.9 ± 3.0. Of 471 patients, 47% (n = 223) presented with a Hunt and Hess score of ≥3 and 76% (n = 357) with a Fisher grade of 3. Treatment was clipping for 69% (279/407) and coiling for 31% (128/407) of patients. Pulmonary complications occurred in 210 of 471 (45%) patients. Nearly one-half of patients were discharged to home (215/471, 46%), and more than one-half had a good outcome defined as a GOS score of 5 at their 1-year (226/403, 56%), 3-year (217/397, 55%), and 6-year (203/380, 53%) follow-up visits. Logistic regression showed age and GCS scores as outcome predictors at all time points, whereas pulmonary complications predicted poor outcome only at the 1-year follow-up visit. CONCLUSIONS Pulmonary problems represent the most common nonneurologic medical complications after aSAH. Despite advances in critical care, pulmonary complications represented predictors of short-term poor outcome only at the 1-year follow-up visit, whereas the medical history of the patient became more relevant for prognosis in long-term follow-up.
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Affiliation(s)
- Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Sam Safavi-Abbasi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sirin Gandhi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Hai Sun
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark E Oppenlander
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joseph M Zabramski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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17
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Bindu B, Mitra R, Singh GP, Phalak M. New Onset Persistent Refractory Hypertension after Medulloblastoma Excision in Children-An Indicator of Poor Prognosis: A Case Series. J Pediatr Neurosci 2018; 13:337-339. [PMID: 30271469 PMCID: PMC6144605 DOI: 10.4103/jpn.jpn_127_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hypertension in the clinical setting of posterior fossa tumors is a known entity and occurs due to medullary compression by the tumor. Such hypertension usually responds to tumor excision. Postoperative hypertension occurring after posterior fossa tumor excision has been attributed to brain stem edema in a single report earlier, which resolved without any intervention. Here, we report two pediatric patients who developed new onset refractory, persistent postoperative hypertension after medulloblastoma excision, and discuss possible causes and the prognostic significance of this condition.
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Affiliation(s)
- Barkha Bindu
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ranadhir Mitra
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Gyaninder P Singh
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Phalak
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Martín-Gallego A, González-García L, Carrasco-Brenes A, Segura-Fernández-Nogueras M, Delgado-Babiano A, Ros-Sanjuán A, Romero-Moreno L, Domínguez-Páez M, Dawid-Milner MS, Arráez-Sánchez MA. Brainstem and Autonomic Nervous System Dysfunction: A Neurosurgical Point of View. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017; 124:221-229. [PMID: 28120078 DOI: 10.1007/978-3-319-39546-3_34] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Central autonomic control nuclei and pathways are mainly integrated within the brainstem, especially in the medulla oblongata. Lesions within these structures can lead to central dysautonomia.Central autonomic control structures can be damaged by tumors, during surgery, or by other neurosurgical pathologies. These may elicit clinical or subclinical autonomic complications that can constitute a serious clinical problem.The authors present a broad review of the central autonomic nervous system, its possible dysfunctions, and the relation between neurosurgery and this "not-well-known system". Preliminary results of an autonomic study of brainstem lesions that is currently being carried out by the authors are also shown.
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Affiliation(s)
- A Martín-Gallego
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain.
| | - L González-García
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - A Carrasco-Brenes
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - M Segura-Fernández-Nogueras
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - A Delgado-Babiano
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - A Ros-Sanjuán
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - L Romero-Moreno
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - M Domínguez-Páez
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - M S Dawid-Milner
- Department of Autonomic Nervous System, CIMES, University of Málaga Foundation (FGUMA), Malaga, Spain
| | - M A Arráez-Sánchez
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
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González Quarante LH, Mena-Bernal JH, Martín BP, Ramírez Carrasco M, Muñoz Casado MJ, Martínez de Aragón A, de las Heras RS. Posterior reversible encephalopathy syndrome (PRES): a rare condition after resection of posterior fossa tumors: two new cases and review of the literature. Childs Nerv Syst 2016; 32:857-63. [PMID: 26584552 DOI: 10.1007/s00381-015-2954-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/05/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In 1996, Hinchey and colleagues coined the term "Posterior reversible encephalopathy syndrome" (PRES) to describe a condition seen in patients with acute neurological symptoms and reversible subcortical vasogenic edema predominantly involving parieto-occipital areas demonstrated in brain MRI. The occurrence of this phenomenon after surgical resection of CNS tumors is typically linked to pediatric cases. MATERIAL AND METHODS Two new cases of PRES after posterior fossa surgery are reported. A thorough review of the literature is carried out with the purpose of updating and summarizing the main features regarding PRES in similar cases. Seven cases of PRES after resection of a posterior fossa tumor have been hitherto reported (4 patients were <20 years old). There is another pediatric case described after a ventriculoperitoneal shunting procedure in a patient with fourth ventricle ependymoma. Two resected tumors were ependymomas, 2 hemangiopericytomas in one patient, 1 pilocyticastrocytoma, 1 vestibular schwannoma, and 1 of the reported cases did not describe the final pathology diagnosis. CASE REPORTS We present 2 new cases of PRES after surgical resection of a posterior fossa tumor (medulloblastoma in case 1 and ependymoma in case 2) in pediatric patients. Case 1 developed delayed seizures and altered mental status(10 days after surgical resection) after receiving treatment with bromocriptine for cerebellar mutism. Case 2 presented with generalized seizures and altered mental status within the first 48 postoperative hours followed by right hemiparesis. Both patients fully recovered and returned to neurological baseline status. A thorough review of the literature was carried out with the purpose of updating and summarizing the main features regarding PRES in similar cases. CONCLUSIONS We report 2 new pediatric cases of posterior reversible encephalopathy syndrome (PRES) that developed after surgical resection of a posterior fossa tumor. Appropriate management includes supportive measures, antihypertensive agents, and antiepileptic drugs, if needed. Full recovery is the most likely outcome in line with previous articles.
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Affiliation(s)
- Lain Hermes González Quarante
- Department of Pediatric Neurosurgery, Hospital General 12 de Octubre, Madrid, Spain.
- Department of Neurosurgery, HGU Gregorio Marañón, Calle Doctor Esquerdo número 46, C.P, 28007, Madrid, Spain.
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Hering D, Schlaich M. The Role of Central Nervous System Mechanisms in Resistant Hypertension. Curr Hypertens Rep 2016; 17:58. [PMID: 26070453 DOI: 10.1007/s11906-015-0570-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Arterial hypertension remains a primary global health problem with significant impact on cardiovascular morbidity and mortality. The low rate of hypertension control and failure to achieve target blood pressure levels particularly among high-risk patients with resistant hypertension has triggered renewed interest in unravelling the underlying mechanisms to implement therapeutic approaches for better patient management. Here, we summarize the crucial role of neurogenic mechanisms in drug-resistant hypertension, with a specific focus on central control of blood pressure, the factors involved in central integration of afferent signalling to increase sympathetic drive in resistant hypertension, and briefly review recently introduced interventional strategies distinctively targeting sympathetic activation.
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Affiliation(s)
- Dagmara Hering
- School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia, Level 3 MRF Building, Rear 50 Murray Street, Perth, WA, 6000 MDBP: M570, Australia,
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Martín-Gallego A, Andrade-Andrade I, Dawid-Milner M, Domínguez-Páez M, Romero-Moreno L, González-García L, Carrasco-Brenes A, Segura-Fernández-Nogueras M, Ros-López B, Arráez-Sánchez M. Autonomic dysfunction elicited by a medulla oblongata injury after fourth ventricle tumor surgery in a pediatric patient. Auton Neurosci 2016; 194:52-7. [DOI: 10.1016/j.autneu.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/28/2015] [Accepted: 12/03/2015] [Indexed: 02/07/2023]
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Sindou M, Mahmoudi M, Brînzeu A. Hypertension of neurogenic origin: effect of microvascular decompression of the CN IX-X root entry/exit zone and ventrolateral medulla on blood pressure in a prospective series of 48 patients with hemifacial spasm associated with essential hypertension. J Neurosurg 2015; 123:1405-13. [DOI: 10.3171/2014.12.jns141775] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
In spite of solid anatomical and physiological arguments and the promising results of Jannetta in the 1970s, treating essential hypertension by microvascular decompression (MVD) of the brainstem has not gained acceptance as a mainstream technique. The main reason has been a lack of established selection criteria. Because of this, the authors' attempts have been limited to patients referred for MVD for hemifacial spasm (HFS) who also had hypertension likely to be related to neurovascular compression (NVC).
METHODS
Of 201 patients referred for HFS, 48 (23.8%) had associated hypertension. All had high-resolution MR images that demonstrated NVC. All underwent MVD of the root exit/entry zone (REZ) of the ninth and tenth cranial nerves (CN IX-X) and adjacent ventrolateral medulla in addition to the CN VII REZ. Effects on hypertension, graded using the WHO classification, were studied up to the latest follow-up, which was 2–16 years from the time of surgery, 7 years on average. Also, effects of MVD on blood pressure (BP) according to the side of vascular compression were evaluated.
RESULTS
Preoperatively, hypertension was severe in all but 1 of the patients; in spite of medical treatment, 47 patients still had WHO Grade 1 or 2 hypertension, and 18 still had unstable BP. After MVD, at latest follow-up, BP had returned to normal (i.e., systolic pressure < 140 mm Hg) in 28 patients; 14 of these patients (29.10% of the whole series) were able to maintain normal BP without any antihypertensive treatment; the other 14 still required some medication to maintain their BP below 140 mm Hg (p < 0.0001). Also, at latest follow-up, BP remained unstable in only 8 of the 18 patients with instability prior to MVD (p < 0.02). Analysis according to side of compression showed that of the 30 patients with left-sided compression, 17 had their BP normalized (without medication in 11 cases), and of the 18 patients with right-sided compression, 11 had their BP normalized (without medication in 3 cases). The difference between sides was not significant.
CONCLUSIONS
These results argue for considering MVD for the treatment of hypertension likely to be due to NVC at the CN IX-X REZ and adjacent ventrolateral medulla. Criteria for selecting patients with hypertension alone still need to be established and could include the following indications: apparently essential hypertension, likely to be neurogenic, in patients in whom high-resolution MRI shows clear-cut images of NVC at the CN IX-X REZ and adjacent ventrolateral medulla and in whom BP cannot be controlled by medical treatment.
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Affiliation(s)
- Marc Sindou
- 1Department of Neurosurgery, University of Lyon 1, Hôpital Neurologique “Pierre Wertheimer,” Lyon, France
| | - Mohamed Mahmoudi
- 1Department of Neurosurgery, University of Lyon 1, Hôpital Neurologique “Pierre Wertheimer,” Lyon, France
- 2Section of Neurosurgery, Regional Military Hospital of Oran (HMRUO), Oran, Algeria; and
| | - Andrei Brînzeu
- 1Department of Neurosurgery, University of Lyon 1, Hôpital Neurologique “Pierre Wertheimer,” Lyon, France
- 3University of Medicine “Victor Babes,” Timisoara, Romania
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Neurovascular compression of medulla oblongata – Association for gestation-induced hypertension. Med Hypotheses 2015. [DOI: 10.1016/j.mehy.2015.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Hypertension is the most common modifiable risk factor for cardiovascular disease and death, and lowering blood pressure with antihypertensive drugs reduces target organ damage and prevents cardiovascular disease outcomes. Despite a plethora of available treatment options, a substantial portion of the hypertensive population has uncontrolled blood pressure. The unmet need of controlling blood pressure in this population may be addressed, in part, by developing new drugs and devices/procedures to treat hypertension and its comorbidities. In this Compendium Review, we discuss new drugs and interventional treatments that are undergoing preclinical or clinical testing for hypertension treatment. New drug classes, eg, inhibitors of vasopeptidases, aldosterone synthase and soluble epoxide hydrolase, agonists of natriuretic peptide A and vasoactive intestinal peptide receptor 2, and a novel mineralocorticoid receptor antagonist are in phase II/III of development, while inhibitors of aminopeptidase A, dopamine β-hydroxylase, and the intestinal Na
+
/H
+
exchanger 3, agonists of components of the angiotensin-converting enzyme 2/angiotensin(1–7)/Mas receptor axis and vaccines directed toward angiotensin II and its type 1 receptor are in phase I or preclinical development. The two main interventional approaches, transcatheter renal denervation and baroreflex activation therapy, are used in clinical practice for severe treatment resistant hypertension in some countries. Renal denervation is also being evaluated for treatment of various comorbidities, eg, chronic heart failure, cardiac arrhythmias and chronic renal failure. Novel interventional approaches in early development include carotid body ablation and arteriovenous fistula placement. Importantly, none of these novel drug or device treatments has been shown to prevent cardiovascular disease outcomes or death in hypertensive patients.
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Affiliation(s)
- Suzanne Oparil
- From the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama (S.O.); and Department of Nephrology and Hypertension, University Hospital of the University Erlangen-Nürnberg, Germany (R.E.S.)
| | - Roland E. Schmieder
- From the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama (S.O.); and Department of Nephrology and Hypertension, University Hospital of the University Erlangen-Nürnberg, Germany (R.E.S.)
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Sindou M. Is there a place for microsurgical vascular decompression of the brainstem for apparent essential blood hypertension? a review. Adv Tech Stand Neurosurg 2015; 42:69-76. [PMID: 25411145 DOI: 10.1007/978-3-319-09066-5_4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There are anatomical and physiological evidences that the ventrolateral (VL) region of the medulla plays an important role in blood pressure regulation and that dysfunction at this level may generate hypertension (HT). Vascular compression by a megadolicho-artery from the vertebrobasilar arterial system at the root entry/exit zone (REZ) of the glossopharyngeal (IXth) and vagal (Xth) cranial nerves (CNs) and the adjacent VL aspect of the medulla has been postulated as a causal factor for HT from neurogenic origin. The first attempts at microvascular decompression (MVD) of the IX-Xth CNs together with the neighbouring VL brainstem was revealed promising. These surgical attempts, as well as the numerous MRI studies, with the goal to detect and identify likely responsible neurovascular conflicts (NVC), are reviewed. Established criteria for indication of MVD as an aetiological treatment of apparent essential HT are still needed.
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Affiliation(s)
- Marc Sindou
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, University Lyon 1, G.H.E, 59 Boulevard Pinel, Lyon, 69003, France,
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Barley J, Ellis C. Microvascular decompression: a surgical option for refractory hypertension of neurogenic etiology. Expert Rev Cardiovasc Ther 2014; 11:629-34. [DOI: 10.1586/erc.13.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Legrady P, Voros E, Bajcsi D, Fejes I, Barzo P, Abraham G. Observations of changes of blood pressure before and after neurosurgical decompression in hypertensive patients with different types of neurovascular compression of brain stem. Kidney Blood Press Res 2013; 37:451-7. [PMID: 24247558 DOI: 10.1159/000355725] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 11/19/2022] Open
Abstract
AIMS The neurovascular pulsatile compression of the rostral ventrolateral medulla can be divided into different subtypes. The posterior inferior cerebellar artery and/or vertebral artery can compress either the rostral ventrolateral medulla or the cranial nerves IX and X or both and on left, right or both sides. METHODS It was retrospectively investigated whether the types of neurovascular compression can influence blood pressure values. Data from 13 resistant hypertensive patients after decompression were investigated. RESULTS Six patients had 2 compressions, two had only medulla compression, four had only nerve compression on the left side and one had 2 compressions on both sides. There was no correlation between the types of compression and the levels of blood pressure, either before or after the decompression. Both, systolic and diastolic blood pressures and pulse pressure also decreased in all cases after the decompression but the change was significant only in the group with 2 compressions on the left side. CONCLUSION According to our data, in a severe hypertension not responding to conventional antihypertensive therapy, the surgical decompression of the brain stem independently of the types of neurovascular compression could guarantee a decrease of blood pressure and improved sensitivity to antihypertensive medication.
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Affiliation(s)
- Peter Legrady
- First Department of Medicine, University of Szeged, Hungary
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Ideguchi M, Kajiwara K, Yoshikawa K, Sadahiro H, Nomura S, Fujii M, Suzuki M. Characteristics of intraoperative abnormal hemodynamics during resection of an intra-fourth ventricular tumor located on the dorsal medulla oblongata. Neurol Med Chir (Tokyo) 2013; 53:655-62. [PMID: 24077276 PMCID: PMC4508747 DOI: 10.2176/nmc.oa2012-0401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abnormal hemodynamics during extirpation of a para-medulla oblongata (MO) tumor is common and may be associated with direct vagal stimulation of the medullary circuit. However, resection of tumors on the dorsal MO may also induce hemodynamic instability without direct vagal stimulus. The objective of this study was to examine the characteristics of hemodynamic instability unrelated to vagal stimulus during dissection of an intra-fourth ventricular tumor with attachment to the dorsal MO. A retrospective analysis was performed in 13 patients. Abnormal hemodynamics were defined as a > 20% change from the means of the intraoperative mean arterial pressure (MAP) and heart rate (HR). Relationships of intraoperative hemodynamics were evaluated with various parameters, including the volume of the MO. Six patients (46.2%) had intraoperative hypertension during separation of the tumor bulk from the dorsal MO. The maximum MAP and HR in these patients were significantly greater than those in patients with normal hemodynamics (116.0 ± 18.0 mmHg versus 85.6 ± 6.5 mmHg; 124.3 ± 22.8 bpm versus 90.5 ± 14.7 bpm). All six cases with abnormal hemodynamics showed hemodynamic fluctuation during separation of the tumor bulk from the dorsal MO. The preoperative volume of the MO in these patients was 1.11 cc less than that in patients with normal hemodynamics, but the volume after tumor resection was similar in the two groups (5.23 cc and 5.12 cc). This suggests that the MO was compressed by the conglutinate tumor bulk, with resultant fluctuation of hemodynamics. Recognition of and preparation for this phenomenon are important for surgery on a tumor located on the dorsal MO.
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Affiliation(s)
- Makoto Ideguchi
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine
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Santisteban MM, Zubcevic J, Baekey DM, Raizada MK. Dysfunctional brain-bone marrow communication: a paradigm shift in the pathophysiology of hypertension. Curr Hypertens Rep 2013; 15:377-89. [PMID: 23715920 PMCID: PMC3714364 DOI: 10.1007/s11906-013-0361-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It is widely accepted that the pathophysiology of hypertension involves autonomic nervous system dysfunction, as well as a multitude of immune responses. However, the close interplay of these systems in the development and establishment of high blood pressure and its associated pathophysiology remains elusive and is the subject of extensive investigation. It has been proposed that an imbalance of the neuro-immune systems is a result of an enhancement of the "proinflammatory sympathetic" arm in conjunction with dampening of the "anti-inflammatory parasympathetic" arm of the autonomic nervous system. In addition to the neuronal modulation of the immune system, it is proposed that key inflammatory responses are relayed back to the central nervous system and alter the neuronal communication to the periphery. The overall objective of this review is to critically discuss recent advances in the understanding of autonomic immune modulation, and propose a unifying hypothesis underlying the mechanisms leading to the development and maintenance of hypertension, with particular emphasis on the bone marrow, as it is a crucial meeting point for neural, immune, and vascular networks.
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Affiliation(s)
- Monica M. Santisteban
- Department of Physiology and Functional Genomics, University of Florida, College of Medicine. 1600 SW Archer Road, PO Box 100274, Gainesville, FL 32610
| | - Jasenka Zubcevic
- Department of Physiology and Functional Genomics, University of Florida, College of Medicine. 1600 SW Archer Road, PO Box 100274, Gainesville, FL 32610
| | - David M. Baekey
- Department of Physiological Sciences, University of Florida, College of Veterinary Medicine. 1600 SW Archer Road, PO Box 100144, Gainesville, FL 32610
| | - Mohan K. Raizada
- Department of Physiology and Functional Genomics, University of Florida, College of Medicine. 1600 SW Archer Road, PO Box 100274, Gainesville, FL 32610
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Barley J, Ellis C. Microvascular decompression surgery for refractory hypertension of neurogenic causes. J Clin Hypertens (Greenwich) 2013; 15:217. [PMID: 23458596 DOI: 10.1111/jch.12019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Patel S, Krishna V, Nicholas J, Welzig CM, Vera C. Preliminary observations on the vasomotor responses to electrical stimulation of the ventrolateral surface of the human medulla. J Neurosurg 2012; 117:150-5. [DOI: 10.3171/2012.3.jns11973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Pulsatile arterial compression (AC) of the ventrolateral medulla (VLM) is hypothesized to produce the hypertension in a subset of patients with essential hypertension. In animals, a network of subpial neuronal aggregates in the VLM has been shown to control cardiovascular functions. Although histochemically similar, neurons have been identified in the retro-olivary sulcus (ROS) of the human VLM, but their function is unclear.
Methods
The authors recorded cardiovascular responses to electrical stimulation at various locations along the VLM surface, including the ROS, in patients who were undergoing posterior fossa surgery for trigeminal neuralgia. This vasomotor mapping of the medullary surface was performed using a bipolar electrode, with stimulation parameters ranging from 5- to 30-second trains (20–100 Hz), constant current (1.5–5 mA), and 0.1-msec pulse durations. Heart rate (HR) and blood pressure (BP) were recorded continuously from baseline (10 seconds before the stimulus) up to 1 minute poststimulus. In 6 patients, 17 stimulation responses in BP and HR were recorded.
Results
The frequency threshold for any cardiovascular response was 20 Hz; the stimulation intensity threshold ranged from 1.5 to 3 mA. In the first patient, all stimulation responses were significantly different from sham recordings (which consisted of electrodes placed without stimulations). Repeated stimulations in the lower ROS produced similar responses in 3 other patients. Two additional patients had similar responses to single stimulations in the lower ROS. Olive stimulation produced no response (control). Hypotensive and/or bradycardic responses were consistently followed by a reflex hypertensive response. Slight right/left differences were noted. No patient suffered short- or long-term effects from this stimulation.
Conclusions
This stimulation technique for vasomotor mapping of the human VLM was safe and reproducible. Neuronal aggregates near the surface of the human ROS may be important in cardiovascular regulation. This method of vasomotor mapping with measures of responses in sympathetic tone (microneurography) should yield additional data for understanding the neuronal network that controls cardiovascular functions in the human VLM. Further studies in which a concentric bipolar electrode is used to generate this type of vasomotor map should also increase understanding of the pathophysiological mechanisms of neurogenically mediated hypertension, and assist in the design of studies to prove the hypothesis that it is caused by pulsatile AC of the VLM.
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Affiliation(s)
- Sunil Patel
- 1Division of Neurosurgery, Department of Neuroscience; and
| | - Vibhor Krishna
- 1Division of Neurosurgery, Department of Neuroscience; and
| | - Joyce Nicholas
- 1Division of Neurosurgery, Department of Neuroscience; and
- 2Division of Biostatistics and Epidemiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | - Cristian Vera
- 1Division of Neurosurgery, Department of Neuroscience; and
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33
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Boogaarts HD, Menovsky T, de Vries J, Verbeek ALM, Lenders JW, Grotenhuis JA. Primary hypertension and neurovascular compression: a meta-analysis of magnetic resonance imaging studies. J Neurosurg 2012; 116:147-56. [DOI: 10.3171/2011.7.jns101378] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Several studies have suggested that neurovascular compression (NVC) of the brainstem might be a cause of hypertension. Because this compression syndrome might be demonstrated by MR imaging studies, several authors have tried to assess its prevalence in small series of patients with hypertension. This article presents a meta-analysis of these studies.
Methods
The studies reviewed by the authors were based on MR imaging and included the presence of left-sided NVC of the left rostral ventrolateral medulla oblongata (RVLM) and/or the cranial nerves IX and X root entry zone in patients with apparent primary hypertension compared with normotensive patients. Several studies also included patients with secondary hypertension as an additional control group, which is analyzed separately.
Results
Meta-analysis included data from 14 studies (597 patients with primary hypertension and 609 controls). The effect size was OR 2.68 (95% CI 1.51–4.75, p = 0.001) (random effect), which is consistent with the hypothesis that NVC of the left RVLM is more frequent in patients with apparent primary hypertension compared with normotensive individuals. Stratification for the study design revealed an effect size for prospective studies of OR 1.97 (95% CI 0.74–5.30, p = 0.178) and for retrospective studies of OR 3.36 (95% CI 1.66–6.79, p = 0.001).
Conclusions
This meta-analysis indicates a statistically significant effect size for left-sided NVC in apparent primary hypertension. However, this effect is absent if subanalysis is confined to prospective studies.
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Affiliation(s)
| | - Tomas Menovsky
- 2Department of Neurosurgery, University Hospital Antwerp, Belgium
| | | | | | - Jacques W. Lenders
- 4General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and
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34
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Tsai MS, Ko YH, Hsu WM, Liang JT, Lai HS, Lee PH, Chang KC. Enhanced Aortic Nerve Growth Factor Expression and Nerve Sprouting in Rats Following Gastric Perforation. J Surg Res 2011; 171:205-11. [DOI: 10.1016/j.jss.2010.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/16/2009] [Accepted: 01/13/2010] [Indexed: 11/28/2022]
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35
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Ideguchi M, Kajiwara K, Yoshikawa K, Kato S, Ishihara H, Fujii M, Fujisawa H, Suzuki M. Continuous hypertension and tachycardia after resection of a hemangioblastoma behind the dorsal medulla oblongata: relationship to sympathetic overactivity at the neurogenic vasomotor center. J Neurosurg 2010; 113:369-73. [DOI: 10.3171/2009.10.jns09504] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A very rare case of continuous hypertension and tachycardia after excision of a cerebellar hemangioblastoma at the dorsal medulla oblongata is presented. This 21-year-old man was admitted to the authors' hospital with a headache and dizziness. Radiological examination revealed a tumor located behind the dorsal medulla oblongata and compressing it substantially. The tumor was completely resected, but after the surgery the patient experienced prolonged hypertension and tachycardia. Postoperative MR imaging showed a small injury at the dorsocaudal medulla that was located at the caudal site of the nucleus of the tractus solitarius (NTS). Because the NTS has been reported to play a central role in cardiovascular regulation along with the rostral ventrolateral medulla, the authors considered it possible that the NTS injury was the cause of the prolonged elevation of sympathetic tone.
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36
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Jannetta PJ, Fletcher LH, Grondziowski PM, Casey KF, Sekula RF. Type 2 diabetes mellitus: A central nervous system etiology. Surg Neurol Int 2010; 1. [PMID: 20847912 PMCID: PMC2940091 DOI: 10.4103/2152-7806.66460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 06/15/2010] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Insulin resistance (hyperinsulinemia) is said to be the signal event and causal in the development of type 2 diabetes mellitus. Pulsatile arterial compression of the right anterolateral medulla oblongata is associated with autonomic dysfunction, including "driving" the pancreas, which increases insulin resistance causing type 2 diabetes mellitus. In this prospective study, we hypothesize that decompressing the right cranial nerve X and medulla will result in better glycemic control in patients with type 2 diabetes mellitus. METHODS Ten patients underwent retromastoid craniectomy with microvascular decompression for type 2 diabetes mellitus. Patients were followed for 12 months postoperatively by blood glucose monitoring and studies of glycemic control, pancreatic function and insulin metabolism. No changes in diet, weight or activity level were permitted during the course of the project. RESULTS Seven of the 10 patients who received microvascular decompression for type 2 diabetes mellitus showed significant improvement in their glucose control. This was noted by measurement of diabetes markers and decrease of diabetes medication dosages. One patient was completely off diabetes medication, while attaining euglucemia. The other 3 patients did not improve in their glucose control. The body mass index of these 3 patients was higher (mean, 34.4) than those with better outcomes (mean, 27.9). CONCLUSION Arterial compression of the right anterolateral medulla appears to be a factor in the etiology of type 2 diabetes mellitus. Microvascular decompression may be an effective treatment for non-obese type 2 diabetes mellitus patients.
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Affiliation(s)
- Peter J Jannetta
- Department of Neurosurgery, Allegheny General Hospital, 420 East North Avenue, Suite 302
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37
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Abstract
This article traces some of the developments in the practice of neurosurgery which have come about dependent upon certain technological advances.
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Affiliation(s)
- Peter J Jannetta
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
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38
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Keravel Y, Sindou M. [Vascular decompression as treatment of essential arterial hypertension]. Neurochirurgie 2009; 55:279-81. [PMID: 19328498 DOI: 10.1016/j.neuchi.2009.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 02/12/2009] [Indexed: 10/21/2022]
Abstract
MVD of the left rostral ventrolateral medulla oblongata may be an effective treatment for patients suffering from intractable severe systemic blood hypertension. This article presents a literature review. Further clinical controlled studies have to be conducted to define precise indications.
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Affiliation(s)
- Y Keravel
- Service de neurochirurgie, hôpital Henri-Mondor, 94010 Créteil cedex, France.
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39
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Symptomatic vertebral artery conflicts to the medulla oblongata and microsurgical treatment options: review of the literature. Neurosurg Rev 2009; 32:143-8; discussion 148-9. [DOI: 10.1007/s10143-008-0182-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Revised: 11/03/2008] [Accepted: 12/06/2008] [Indexed: 10/21/2022]
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40
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Frank H, Heusser K, Geiger H, Fahlbusch R, Naraghi R, Schobel HP. Temporary Reduction of Blood Pressure and Sympathetic Nerve Activity in Hypertensive Patients After Microvascular Decompression. Stroke 2009; 40:47-51. [DOI: 10.1161/strokeaha.108.518670] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Experimental studies suggested neurovascular compression of the brain stem as a cause of hypertension. The aim of our prospective study was to investigate the effect of microvascular decompression in patients with severe hypertension with neurovascular compression on blood pressure and central sympathetic nerve activity in the long-term.
Methods—
Fourteen patients (4 males; mean age, 46±8 years) with essential hypertension underwent microvascular decompression of the brain stem. Vasoconstrictor muscle sympathetic nerve activity (recorded by microneurography: burst frequency, bursts/min) and blood pressure (24-hour profiles) were investigated before surgery and 7 days, 3 months, and every 6 months postoperatively.
Results—
Muscle sympathetic nerve activity was preoperatively elevated and decreased significantly postoperatively (35±13 bursts/min vs 20±9 bursts/min;
P
<0.01). Sympathetic activity remained reduced 3 months (19±8bursts/min;
P
<0.01), 6 months (19±7 bursts/min;
P
<0.01), and 12 months (23±9 bursts/min;
P
<0.01) postoperatively. However, in the long-term, sympathetic nerve activity increased again (18 months after surgery: 28±10 bursts, not significant; 24 months postoperatively: 34±12 bursts/min, not significant). Systolic and diastolic blood pressure decreased from 162±6/98±5 mm Hg preoperatively to 133±6/85±4 mm Hg (7 days postoperatively;
P
<0.01); 136±5/86±4 mm Hg (3 months postoperatively;
P
<0.01); 132±4/85±4 mm Hg (6 months postoperatively;
P
<0.01); 132±3/85±5 mm Hg (12 months postoperatively;
P
<0.01); 132±5/84±5 mm Hg;
P
<0.01). Twenty-four months after microvascular decompression, blood pressure increased again up to 158±7/96±6 mm Hg, corresponding to the sympathetic nerve activity course.
Conclusion—
Sympathetic nerve activity and blood pressure are temporary reduced by microvascular decompression in patients with severe hypertension with neurovascular compression. The data are a hint for sympathetic overactivity as a pathomechanism in this subgroup of patients.
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Affiliation(s)
- Helga Frank
- From Department of Nephrology (H.F.), Klinikum rechts der Isar, Technische Universitaet Muenchen, Germany; Department of Clinical Pharmacology (K.H.), Hannover Medical School, Hannover, Germany; Department of Nephrology (H.G.), University of Frankfurt, Germany; International Neuroscience Institute Hannover (R.F.), Germany; Department of Neurosurgery (R.N.), University of Erlangen-Nuremberg, Germany; Benedictus Krankenhaus Tutzing (H.P.S.), Germany
| | - Karsten Heusser
- From Department of Nephrology (H.F.), Klinikum rechts der Isar, Technische Universitaet Muenchen, Germany; Department of Clinical Pharmacology (K.H.), Hannover Medical School, Hannover, Germany; Department of Nephrology (H.G.), University of Frankfurt, Germany; International Neuroscience Institute Hannover (R.F.), Germany; Department of Neurosurgery (R.N.), University of Erlangen-Nuremberg, Germany; Benedictus Krankenhaus Tutzing (H.P.S.), Germany
| | - Helmut Geiger
- From Department of Nephrology (H.F.), Klinikum rechts der Isar, Technische Universitaet Muenchen, Germany; Department of Clinical Pharmacology (K.H.), Hannover Medical School, Hannover, Germany; Department of Nephrology (H.G.), University of Frankfurt, Germany; International Neuroscience Institute Hannover (R.F.), Germany; Department of Neurosurgery (R.N.), University of Erlangen-Nuremberg, Germany; Benedictus Krankenhaus Tutzing (H.P.S.), Germany
| | - Rudolf Fahlbusch
- From Department of Nephrology (H.F.), Klinikum rechts der Isar, Technische Universitaet Muenchen, Germany; Department of Clinical Pharmacology (K.H.), Hannover Medical School, Hannover, Germany; Department of Nephrology (H.G.), University of Frankfurt, Germany; International Neuroscience Institute Hannover (R.F.), Germany; Department of Neurosurgery (R.N.), University of Erlangen-Nuremberg, Germany; Benedictus Krankenhaus Tutzing (H.P.S.), Germany
| | - Ramin Naraghi
- From Department of Nephrology (H.F.), Klinikum rechts der Isar, Technische Universitaet Muenchen, Germany; Department of Clinical Pharmacology (K.H.), Hannover Medical School, Hannover, Germany; Department of Nephrology (H.G.), University of Frankfurt, Germany; International Neuroscience Institute Hannover (R.F.), Germany; Department of Neurosurgery (R.N.), University of Erlangen-Nuremberg, Germany; Benedictus Krankenhaus Tutzing (H.P.S.), Germany
| | - Hans P. Schobel
- From Department of Nephrology (H.F.), Klinikum rechts der Isar, Technische Universitaet Muenchen, Germany; Department of Clinical Pharmacology (K.H.), Hannover Medical School, Hannover, Germany; Department of Nephrology (H.G.), University of Frankfurt, Germany; International Neuroscience Institute Hannover (R.F.), Germany; Department of Neurosurgery (R.N.), University of Erlangen-Nuremberg, Germany; Benedictus Krankenhaus Tutzing (H.P.S.), Germany
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41
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First description of neurogenic sinus bradycardia in idiopathic hemifacial spasm. ACTA ACUST UNITED AC 2008; 71:70-3. [PMID: 18207506 DOI: 10.1016/j.surneu.2007.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 08/02/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Idiopathic HFS accompanied by NSB is a rare clinical phenomenon and has not been reported before. Here we describe this phenomenon and discuss its mechanism and treatment. METHODS Eighteen patients with idiopathic HFS with NSB (HR < or =55 BPM) received MVD operations. Their sinus bradycardia was proved to be neurogenic by a series of examinations. During MVD, all 18 patients were found to have their REZ of facial and vagus nerves or VMO compressed by intracranial arteries. Decompression at REZ of facial and vagus nerves and/or VMO was enforced in MVD operations. Preoperative and postoperative HR and the therapeutic efficacy of MVD for HFS with NSB were recorded. RESULTS Fourteen cases (77.78%) were right-sided HFS. The symptom of facial spasm disappeared in 16 cases and was relieved in 1 case a year after MVD. The mean HR before MVD was 52 +/- 2.81 BPM. The mean HRs 1 week and 1 year after MVD were 63.39 +/- 5.26 and 63.17 +/- 6.46 BPM, respectively, both of which were significantly higher (P < .01) than the preoperative HR. CONCLUSIONS Most NSBs occurred in right-sided HFS. Decompression at REZ of facial and vagus nerves and/or VMO simultaneously was an effective treatment of HFS and NSB in HFS accompanied by NSB. Severe artery compression at vagus or VMO might be the cause of NSB in HFS.
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42
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Pico F, Labreuche J, Hauw JJ, Amarenco P. Dolicoectasie arteriose intracraniche. Neurologia 2008. [DOI: 10.1016/s1634-7072(08)70526-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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43
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Grassi G. Blood pressure lowering effects of non-surgical procedures for vascular decompression: good news to be taken with caution. J Hum Hypertens 2007; 21:341-2. [PMID: 17252031 DOI: 10.1038/sj.jhh.1002134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- G Grassi
- Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Monza (Milan), Italy.
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44
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Stevens MF, Hermanns H, Freynhagen R, Novotny GEK, Lipfert P. Regeneration of baroafferents after implantation into different vessels. J Peripher Nerv Syst 2007; 12:40-9. [PMID: 17374100 DOI: 10.1111/j.1529-8027.2007.00115.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Regeneration of peripheral nerves involves an essential contribution by surrounding tissues. This study focuses on the role of the target tissue on the regeneration of afferent peripheral nerves. We hypothesized that nerves implanted into the appropriate target tissue regain their function, whereas they degenerate when implanted into a different tissue. Therefore, aortic nerves of rabbits were transected and implanted into arteries or veins, and their function and structure was reevaluated after 1.5, 3, and 10 months. In a subset of animals, the nerves were again severed and implanted into the other vessel. Twelve of 18 nerves implanted into arteries regained typical neurophysiological activity, but none of those implanted into veins. Two times even baroreflexes were elicited through the newly built nerve endings. The structure of the nerve endings implanted into arteries resembled baroreceptors, whereas no fiber growth was detected in veins. Morphometrically, the fiber number and diameter increased over the observed time period after implantation into arteries. Nerves implanted into veins, transected after 3 months, and then implanted into arteries also regained neurophysiological activity. Again, they rebuilt baroreceptors and significantly increased their fiber number and diameter. In conclusion, when severed baroafferents are implanted into arteries, they regenerate new baroreceptors and restore the normal myelination and fiber size of the nerve over time, whereas veins seem to inhibit nerve fiber sprouting and regeneration of severed fibers.
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Affiliation(s)
- Markus F Stevens
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany.
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45
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Pickering TG. Neurovascular Compression of the Medulla: Can It Cause Neurogenic Hypertension? J Clin Hypertens (Greenwich) 2007; 9:63-6. [PMID: 17215662 PMCID: PMC8109868 DOI: 10.1111/j.1524-6175.2007.05980.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas G Pickering
- Behavioral Cardiovascular Health and Hypertension Program, Columbia Presbyterian Medical Center, New York, NY 10032, USA.
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46
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Agrawal A, Timothy J, Pandit L, Kumar A, Singh G, Lakshmi R. NEUROGENIC PULMONARY OEDEMA. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2007. [DOI: 10.29333/ejgm/82417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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47
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Nakamura T, Osawa M, Uchiyama S, Iwata M. Arterial Hypertension in Patients with Left Primary Hemifacial Spasm Is Associated with Neurovascular Compression of the Left Rostral Ventrolateral Medulla. Eur Neurol 2007; 57:150-5. [PMID: 17213721 DOI: 10.1159/000098466] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 10/07/2006] [Indexed: 11/19/2022]
Abstract
The aim of the study was to clarify the relationship between neurovascular compression of the rostral ventrolateral medulla and arterial hypertension in patients with primary hemifacial spasm. We enrolled 82 patients with primary hemifacial spasm and 82 age- and sex-matched magnetic resonance imaging (MRI) controls of the posterior cranial fossa. Neurovascular compression of the rostral ventrolateral medulla was assessed by MRI, and its association with arterial hypertension was investigated. No significant differences were found in prevalence of arterial hypertension between patients with primary hemifacial spasm and control subjects (39.0 vs. 29.3%, p=0.19). Thirty-two percent of the patients with left primary hemifacial spasm (n=44) and 47% of the patients with right primary hemifacial spasm (n=38) were hypertensive. Neurovascular compression of the left rostral ventrolateral medulla was observed in 86% of those with left (ipsilateral) primary hemifacial spasm with arterial hypertension (n=14) and 33% of those with left (ipsilateral) primary hemifacial spasm without (n=30). The association between neurovascular compression of the left rostral ventrolateral medulla and arterial hypertension was significant in patients with left (ipsilateral) primary hemifacial spasm (p=0.0012), but not in patients with right (contralateral) primary hemifacial spasm (p=0.18). Neurovascular compression of the left rostral ventrolateral medulla was more frequently observed in hypertensive patients with left primary hemifacial spasm, and neurovascular compression of the left rostral ventrolateral medulla correlated with arterial hypertension in these patients. These results are of potential clinical importance for the treatment of primary hemifacial spasm with arterial hypertension.
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Affiliation(s)
- Tomomi Nakamura
- Department of Neurology, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
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48
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Ceral J, Zizka J, Eliás P, Solar M, Klzo L, Reissigová J. Neurovascular compression in essential hypertension: cause, consequence or unrelated finding? J Hum Hypertens 2006; 21:179-81. [PMID: 17136105 DOI: 10.1038/sj.jhh.1002124] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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49
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Kan P, Couldwell WT. Posterior fossa brain tumors and arterial hypertension. Neurosurg Rev 2006; 29:265-9; discussion 269. [PMID: 16924459 DOI: 10.1007/s10143-006-0036-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 03/16/2006] [Accepted: 04/30/2006] [Indexed: 11/29/2022]
Abstract
Hypertension caused by arterial compression of the rostral ventrolateral medulla is well described. Much less information is available on the association between neurogenic hypertension and posterior fossa brain tumors. To date, multiple reports have supported the impression that a small subpopulation of patients with posterior fossa tumors can present with arterial hypertension, and many of those patients achieved significant improvement of their hypertension after tumor resection and medullary decompression. To review the relationship between posterior fossa brain tumors and hypertension, we detail the history, basic science, and clinical reports along with an illustrative case regarding this topic.
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Affiliation(s)
- Peter Kan
- Department of Neurosurgery, University of Utah School of Medicine, 30 North 1900 East, Suite 3B409, Salt Lake City, 84132, USA
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50
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Kamel MH, Mansour NH, Mascott C, Aquilina K, Young S. Compression of the Rostral Ventrolateral Medulla by a Vagal Schwannoma of the Cerebellomedullary Cistern Presenting with Refractory Neurogenic Hypertension: Case Report. Neurosurgery 2006; 58:E1212; discussion E1212. [PMID: 16723872 DOI: 10.1227/01.neu.0000215991.01402.4f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractOBJECTIVE:The rostral ventrolateral medulla is thought to serve as a final common pathway for the integration of central cardiovascular information and to be important for the mediation of central pressor responses. An association between essential hypertension and neurovascular compression of the rostral ventrolateral medulla has been reported. This may be mediated by an increase in sympathetic tone.CLINICAL PRESENTATION:Schwannomas arising from the lower cranial nerves (Cranial Nerves IX-XI) are rare, constituting only 3% of all intracranial schwannomas unassociated with neurofibromatosis. The majority of these tumors present as jugular foramen lesions and, less commonly, they occur along the extracranial course of these nerves. An intracisternal location is extremely rare. Fewer than 15 cases of pathologically proven intracisternal vagal schwannomas in the absence of neurofibromatosis have been reported.INTERVENTION:We report a case of vagal schwannoma in the cerebellomedullary cistern causing distortion of the vagal root entry zone and presenting with refractory neurogenic hypertension. Total microsurgical excision of this tumor, arising from one of the rootlets of the vagus nerve, was achieved. Immediately postoperatively, blood pressure decreased markedly, and despite our effort to maintain the blood pressure with fluids, the patient developed a cerebral infarction in the watershed zone.CONCLUSION:We discuss the proposed mechanism of hypertension, and the perioperative management, stressing blood pressure control. A review of the literature regarding vagal schwannomas is also presented. To the best of our knowledge, this is the first case report of a cerebellomedullary cistern vagal schwannoma presenting with neurogenic hypertension.
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Affiliation(s)
- Mahmoud H Kamel
- National Department of Neurology, Beaumont Hospital, Dublin, Ireland.
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