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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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Kalher M, Kaushik M, Vasudevan H, Narendran S, Mani KK, Ramakrishnan K, Rangarajan V, Shah VM. Clinical Profile of Patients with Hemifacial Spasm at a Tertiary Eye Care Center in South India: A Retrospective Study. J Curr Ophthalmol 2023; 35:395-400. [PMID: 39281403 PMCID: PMC11392308 DOI: 10.4103/joco.joco_295_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 09/18/2024] Open
Abstract
Purpose To assess the incidence and clinical profile of hemifacial spasm (HFS) and the association between HFS and systemic diseases. Methods This retrospective study was carried out on 85 patients with HFS, presenting at a tertiary eye care center in South India. Demographic and clinical details were recorded for all patients. Of these, the patients who had undergone magnetic resonance imaging (MRI) of the brain were analyzed for primary and secondary HFS. Results The mean age of the patients was 56.11 ± 12.51 years. The age at onset of HFS was 54.9 ± 12.7 years. The disease duration was 9.51 ± 7.28 years. Male:female ratio was 1:1.17. The right side was involved in 31 patients (36.47%) and the left side in 54 patients (63.52%). MRI was performed in 54 (63.52%) patients and showed neurovascular conflict in 22 (40.74%) patients and space-occupying lesions in 2 (3.70%) patients. Forty-nine (57.64%) patients had primary HFS, while five (5.88%) patients had secondary HFS due to old facial palsy in 3 and space-occupying lesions in two patients. Twenty (23.52%) patients received botulinum toxin A with a good response. Type of HFS had a significant association with hypertension (P = 0.046) while no significant association was present between laterality of HFS and systemic diseases (P > 0.05 each). Multivariate analysis showed a marginally significant association between type of HFS and hypertension (P = 0.057). Conclusions Primary HFS was the main type of HFS with female dominance and predilection for the left side. Hypertension had a relationship with HFS that needs to be investigated further for its causal nature.
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Affiliation(s)
- Manisha Kalher
- Department of General Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Madhurima Kaushik
- Department of General Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Haritha Vasudevan
- Department of General Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | | | - Karthik Kumar Mani
- Department of General Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Kavitha Ramakrishnan
- Department of General Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Viji Rangarajan
- Orbit and Oculoplasty Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Virna Mahesh Shah
- Neuro-Ophthalmology Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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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 for Hemifacial Spasm Associated with Vertebral Artery: Biomedical Glue−Coated Teflon Sling Transposition Technique. World Neurosurg 2018; 120:e342-e348. [DOI: 10.1016/j.wneu.2018.08.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 11/23/2022]
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Hermier M. Imaging of hemifacial spasm. Neurochirurgie 2018; 64:117-123. [DOI: 10.1016/j.neuchi.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/15/2018] [Accepted: 01/27/2018] [Indexed: 10/17/2022]
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Sindou M, Mercier P. Hemifacial spasm associated with other cranial nerve syndromes: Literature review. Neurochirurgie 2018; 64:101-105. [DOI: 10.1016/j.neuchi.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/02/2018] [Accepted: 01/13/2018] [Indexed: 11/30/2022]
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The association between vertebrobasilar dolichoectasia and hemifacial spasm. Parkinsonism Relat Disord 2016; 32:54-59. [DOI: 10.1016/j.parkreldis.2016.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/27/2016] [Accepted: 08/16/2016] [Indexed: 11/21/2022]
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8
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Chung M, Han I, Chung SS, Huh R. Side predilections of offending arteries in hemifacial spasm. J Clin Neurosci 2016; 29:106-10. [DOI: 10.1016/j.jocn.2015.10.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/11/2015] [Indexed: 11/16/2022]
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9
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Revisiting the link between hypertension and hemifacial spasm. Sci Rep 2016; 6:21082. [PMID: 26891766 PMCID: PMC4759578 DOI: 10.1038/srep21082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 01/08/2016] [Indexed: 11/08/2022] Open
Abstract
The relationship between hypertension and hemifacial spasm (HFS) has been debated. Microvascular decompression surgery is effective in some HFS patients with uncontrolled hypertension. To address current gaps in knowledge, we conducted a meta-analysis of case-control studies that have examined the prevalence of hypertension in HFS patients compared to non-HFS controls. We also evaluated the implications and limitations of the pooled studies. We identified 62 studies from PubMed, The Cochrane Library, Web of Science and Scholar.google.com and six studies that fit our inclusion criteria were included. A random-effects model was used to derive the pooled estimate of the Odds Ratio. The data was plotted on a Forest plot. A pooled analysis involving 51585 subjects, 549 cases, 720 neurological controls and 50316 controls from the general population, showed that HFS patients had a higher chance of developing hypertension (OR = 1.72, 95% CI = (1.12, 2.31), p-value <0.001). The prevalence of hypertension was higher in HFS patients as compared to non-HFS patients. This meta-analysis highlights a positive correlation between hypertension and HFS. Blood pressure should be closely monitored during the follow-up of HFS patients. Preliminary links between ventrolateral medullary (VLM) compression and HFS should be further evaluated in future studies.
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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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Rudzińska M, Wójcik-Pędziwiatr M, Malec-Litwinowicz M, Grabska N, Hartel M, Flak M, Szczudlik A. Is hypertension a risk factor of hemifacial spasm? Neurol Neurochir Pol 2015; 50:69-74. [PMID: 26969561 DOI: 10.1016/j.pjnns.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/20/2015] [Accepted: 11/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The published data on the relation between arterial hypertension (AH) and hemifacial spasm (HFS) are controversial. The aim of the study was to determine the prevalence of AH in HFS patients and the relation of AH and compression of the brainstem at the region of vasomotor center. MATERIALS AND METHODS The study included 60 of primary HFS patients and 60 healthy controls matched by age. AH was defined according to WHO criteria. The vessel compression of the brainstem was measure on MRI scans in selected region of vasomotor center located in the ventro-lateral medulla (VLM), between the pontomedullary junction, retro-olivary sulcus and the root entry zone (REZ) of the IX and X nerves. Modeling and compression severity of the VLM was graded in the 0-3 scale. RESULTS The prevalence of AH in HFS patients did not differ significantly from the control group (61.6% vs 45.0%, p=ns). VML compression by vessel was frequently found in HFS patients with AH than without AH (97.2% vs 60.9%, χ(2)=11.0, p=0.0009). A similar relation was also found in the control group. The higher rate of VML vascular compression was related to the presence of AH in both, HFS patients and control group. CONCLUSION The prevalence of AH in HFS patients does not differ from controls. The VLM compression in HFS patients and controls is related to AH diagnosis. The association between AH and VLM compression is stronger in patients with higher degree of VLM compression.
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Affiliation(s)
- Monika Rudzińska
- Department of Neurology, Medical University of Silesia, Faculty of Medicine, Katowice, Poland.
| | - Magdalena Wójcik-Pędziwiatr
- Department of Neurology with Unit of Stroke and Unit of Neurological Rehabilitation, The John Paul II Hospital, Krakow, Poland
| | - Michalina Malec-Litwinowicz
- Department of Neurology with Unit of Stroke and Unit of Neurological Rehabilitation, The John Paul II Hospital, Krakow, Poland
| | - Natalia Grabska
- Department of Neurology with Unit of Stroke and Unit of Neurological Rehabilitation, The John Paul II Hospital, Krakow, Poland
| | | | - Maria Flak
- Department of Neurology, Medical University of Silesia, Faculty of Medicine, Katowice, Poland
| | - Andrzej Szczudlik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Alafaci C, Granata F, Cutugno M, Grasso G, Salpietro FM, Tomasello F. Presurgical evaluation of hemifacial spasm and spasmodic torticollis caused by a neurovascular conflict from AICA with 3T MRI integrated by 3D drive and 3D TOF image fusion: A case report and review of the literature. Surg Neurol Int 2014; 5:108. [PMID: 25101203 PMCID: PMC4123266 DOI: 10.4103/2152-7806.136887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/17/2014] [Indexed: 11/04/2022] Open
Abstract
Background: Hemifacial spasm (HS) and spasmodic torticollis (ST) are well-known disorders that are caused by a neurovascular conflict. HS is characterized by irregular, involuntary muscle contractions on one side of the face due to spasms of orbicularis oris and orbicularis oculi muscles, and is usually caused by vascular compression of the VII cranial nerve. ST is an extremely painful chronic movement disorder causing the neck to involuntary turn to the side, upward and/or downward. HS is usually idiopathic but it is rarely caused by a neurovascular conflict with the XI cranial nerve. Case Description: We present a case of a 36-year-old woman with a 2-year history of left hemifacial spasm and spasmodic torticollis. Pre-surgical magnetic resonance imaging MRI examination was performed with 3TMRI integrated by 3Ddrive and 3DTOF image fusion. Surgery was performed through a left suboccipital retrosigmoid craniectomy. The intraoperative findings documented a transfixing artery penetrating the facial nerve and a dominant left anteroinferior cerebellar artery (AICA) in contact with the anterior surface of the pons and lower cranial nerves. Microvascular decompression (MVD) was performed. Postoperative course showed the regression of her symptoms. Conclusions Transfixing arteries are rarely reported as a cause of neurovascular conflicts. The authors review the literature concerning multiple neurovascular conflicts.
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Affiliation(s)
- Concetta Alafaci
- Department of Neurosurgery, Papardo Piemonte Hospital, University of Messina, Messina, Italy
| | - Francesca Granata
- Department of Neuroradiology, Papardo Piemonte Hospital, University of Messina, Messina, Italy
| | - Mariano Cutugno
- Department of Neurosurgery, Papardo Piemonte Hospital, University of Messina, Messina, Italy
| | - Giovanni Grasso
- Department of Neurosurgery, University of Palermo, Palermo, Italy
| | - Francesco M Salpietro
- Department of Neurosurgery, Papardo Piemonte Hospital, University of Messina, Messina, Italy
| | - Francesco Tomasello
- Department of Neurosurgery, Papardo Piemonte Hospital, University of Messina, Messina, Italy
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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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14
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Sandell T, Holmen J, Eide PK. Hypertension in patients with cranial nerve vascular compression syndromes and comparison with a population-based cohort. J Neurosurg 2013; 119:1302-8. [PMID: 23991839 DOI: 10.3171/2013.7.jns13231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Although essential arterial hypertension (AH) represents a major health issue, its underlying causes remain unknown. An intriguing hypothesis is that AH in some cases may be caused by vascular compression of the rostral ventrolateral medulla (RVLM). Because hemifacial spasms (HFSs) are caused by vascular compression of the seventh cranial nerve in close proximity to the RVLM, one would, if this hypothesis is correct, expect to find a positive association between the occurrence of AH and chronic HFSs. Such a positive association would not be expected in patients with trigeminal neuralgia (TN), since TN is caused by vascular compression of the fifth cranial nerve, which is not close to the RVLM. METHODS In view of this background, the authors conducted a retrospective population-based study to investigate how the occurrence of AH in patients with either HFSs or TN compares with the prevalence of AH in the general population, when adjusted for sex and age. The general population was represented by participants of the Nord-Trøndelag Health Study 3 (HUNT3). RESULTS The prevalence of AH in the authors' patients with HFSs was significantly higher than in a sex- and age-adjusted sample from the general population; this was not true for the patients with TN. CONCLUSIONS The authors suggest that the data provide supporting evidence to the theory that compression of the RVLM may be one cause of AH.
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Affiliation(s)
- Tiril Sandell
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet
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15
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Effect of left-sided brain stem decompression on blood pressure and short-term cardiovascular regulation in resistant hypertension. Hypertens Res 2012; 35:1118-9. [PMID: 22932873 DOI: 10.1038/hr.2012.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Inglott MA, Farnham MMJ, Pilowsky PM. Intrathecal PACAP-38 causes prolonged widespread sympathoexcitation via a spinally mediated mechanism and increases in basal metabolic rate in anesthetized rat. Am J Physiol Heart Circ Physiol 2011; 300:H2300-7. [PMID: 21460201 DOI: 10.1152/ajpheart.01052.2010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The rostral ventrolateral medulla differentially regulates sympathetic output to different vascular beds, possibly through the release of various neurotransmitters and peptides that may include pituitary adenylate cyclase-activating polypeptide (PACAP). An intrathecal administration of PACAP increases splanchnic sympathetic nerve activity and heart rate, but not mean arterial blood pressure. The mechanism behind this response is unknown but may be due to a differential control of sympathetic outflows. In this study we sought 1) to investigate whether intrathecal PACAP differentially affects sympathetic outflow, 2) to determine whether the intrathecal responses to PACAP are solely due to a spinally mediated mechanism, and 3) to determine whether intrathecal PACAP affects metabolic function. Experiments using urethane-anesthetized, vagotomized, ventilated, and paralyzed adult male Sprague-Dawley rats were conducted in this study. Intrathecal injections of PACAP-38 were given, and mean arterial pressure, heart rate, the activity of regional sympathetic nerves, end-tidal CO(2), and core temperature were recorded. The novel findings of this study are that 1) intrathecal PACAP-38 causes a prolonged widespread sympathoexcitation in multiple sympathetic beds, 2) this widespread sympathoexcitation is mediated within the spinal cord itself since spinal transection does not abrogate the response, and 3) that intrathecal PACAP-38 increases basal metabolic rate. Therefore, we conclude that intrathecal PACAP acts in the spinal cord to cause a prolonged widespread sympathoexcitation and that PACAP also causes an increase in basal metabolic rate that includes an increase in brown adipose tissue thermogenesis in our rat preparation.
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Affiliation(s)
- Melissa A Inglott
- Australian School of Advanced Medicine, L1, F10A, Macquarie Univ., NSW 2109, Sydney, Australia
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Zhong J, Li ST, Zhu J, Guan HX. Is entire nerve root decompression necessary for hemifacial spasm? Int J Surg 2010; 9:254-7. [PMID: 21184849 DOI: 10.1016/j.ijsu.2010.12.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 12/04/2010] [Accepted: 12/14/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The root exit zone (REZ) of the seventh cranial nerve has been the target of microvascular decompression surgery (MVD) while searching the neurovascular conflict for treatment of hemifacial spasm for long time. Recently, increasing cases regarding the offending vessel beyond the REZ have been reported. To verify whether a thorough dissection of the nerve may give rise to a better postoperative result without enhancing complications, we conducted a parallel investigation. PATIENTS AND METHODS 112 Connective entire-nerve-exposed MVDs were performed and compared to 186 REZ-exposed MVDs performed by the same group of surgeons in 2009. The surgical findings, postoperative outcomes and complications as well as microscopic operating time were examined. RESULTS Immediately after the surgery, the outcomes were excellent in 98.2%, good in 1.8% and poor in 0% in the entire-nerve-exposed group, compared to excellent in 92.5%, good in 1.6% and poor in 5.9% in the REZ-exposed group. The difference of outcomes between the two groups were statistically significant (χ(2)=4.6845, P=0.0304), but not the complications and microscopic operating time. Nine of the 11 poor-outcome patients from the REZ-exposed group were then reoperated on within a few days, and their symptoms disappeared in eight patients. The main reason for the failed surgeries was that the offending vessels beyond REZ were missed. CONCLUSIONS These findings suggested that the entire-root-decompression technique is recommended while performing MVDs in patients with hemifacial spasm.
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Affiliation(s)
- Jun Zhong
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, The Cranial Nerve Disease Center of Shanghai, 1665 KongJiang Rd., Shanghai 200092, China
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Saberi H, Meybodi AT, Zeinalizadeh M. Normalization of systemic arterial hypertension following removal of posterior fossa hemangioblastoma: a case report. CASES JOURNAL 2009. [PMID: 20181189 PMCID: PMC2827080 DOI: 10.1186/1757-1626-2-7106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The concept of compression of the rostral ventrolateral medulla as a cause for hypertension is gaining more and more interest. This report is about a 36-year-old male with a three years history of hypertension who presented with a posterior fossa mass suggestive of a hemangioblastoma. Laboratory and imaging studies ruled out the presence of von Hippel-Lindau disease and/or concomitant pheochromocytoma. Post-surgical blood pressure monitoring revealed a 40 mmHg decline in blood pressure. It could be hypothesized that alleviation the compressive effect of the tumour on the rostral ventrolateral medulla as proposed by previous studies could be a contributing factor.
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Saberi H, Meybodi AT, Zeinalizadeh M. Normalization of systemic arterial hypertension following removal of posterior fossa hemangioblastoma: a case report. CASES JOURNAL 2009; 2:7106. [PMID: 20181189 PMCID: PMC2827080 DOI: 10.1186/1757-1626-0002-0000007106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 02/19/2009] [Indexed: 05/28/2023]
Abstract
The concept of compression of the rostral ventrolateral medulla as a cause for hypertension is gaining more and more interest. This report is about a 36-year-old male with a three years history of hypertension who presented with a posterior fossa mass suggestive of a hemangioblastoma. Laboratory and imaging studies ruled out the presence of von Hippel-Lindau disease and/or concomitant pheochromocytoma. Post-surgical blood pressure monitoring revealed a 40 mmHg decline in blood pressure. It could be hypothesized that alleviation the compressive effect of the tumour on the rostral ventrolateral medulla as proposed by previous studies could be a contributing factor.
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Affiliation(s)
- Hooshang Saberi
- Departement of Neurosurgery, Brain and Spinal Injuries Repair Research Center (BASIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, 14197, Iran
| | - Ali Tayebi Meybodi
- Departement of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, 14197, Iran
| | - Mehdi Zeinalizadeh
- Departement of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, 14197, Iran
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Chan LL, Lee E, Fook-Chong S, Tan EK. Case control MR-CISS and 3D TOF MRA imaging study of medullary compression and hypertension in hemifacial spasm. Mov Disord 2008; 23:1820-4. [DOI: 10.1002/mds.22034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Tan EK, Chan LL. Neurovascular compression syndromes and hypertension: clinical relevance. ACTA ACUST UNITED AC 2007; 3:416-7. [PMID: 17609652 DOI: 10.1038/ncpneuro0558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Accepted: 05/17/2007] [Indexed: 11/09/2022]
Affiliation(s)
- Eng-King Tan
- Department of Neurology, Singapore General Hospital, National Neuroscience Institute, Singapore.
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