1
|
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.
Collapse
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
| |
Collapse
|
2
|
Zhu J, Gu R, Ji F. Microvascular decompression can effectively reduce arterial blood pressure in patients with Trigeminal Neuralgia. Clin Neurol Neurosurg 2023; 233:107945. [PMID: 37611352 DOI: 10.1016/j.clineuro.2023.107945] [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: 07/04/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Microvascular decompression (MVD) has been used in the treatment of Trigeminal Neuralgia (TN) and arterial hypertension (HTN). Results of several reports have supported its clinical effectiveness, however, little attention has been paid on arterial blood pressure changes caused by MVD in patients with TN. METHODS In this single-center retrospective study, a cohort of 80 patients with TN who underwent MVD between 2021 and 2022 had been reviewed. Clinical data such as age, gender, pain duration, operation time, side and range of pain, HTN history, treatment history, VAS score, mean arterial pressure (MAP), and nausea or vomiting after operation were collected and analyzed via Linear regression to select possible related factors. Then, multiple linear regression of the possible predictors was used to identify the variables that significantly predicted MAP reduction. RESULTS The VAS scores of TN patients after MVD surgery was significantly lower than that before operation, irrespective of the gender, side and range of pain, HTN history, RF history, and PONV (Wilcoxon test, P < 0.001). MVD can significantly decreased the blood pressure of TN patients, without interference from other factors. (MAP reduction ratio=14.46% ± 12.32%) (paired t-test, P < 0.001). The univariate and Multiple linear regression analysis showed that the preoperative MAP was significantly related to MAP reduction ratio (P < 0.001). CONCLUSIONS In patients with TN, MVD can significantly decrease arterial blood pressure. Blood pressure reductions were more prominent when cases with higher preoperative MAP.
Collapse
Affiliation(s)
- Jin Zhu
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Rui Gu
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Fan Ji
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
| |
Collapse
|
3
|
Zhang W, Deng G, Hu J, Yan R, Hu J, Fan J. Effects of Carvedilol on Blood Pressure, Blood Sugar, and Blood Lipids in Elderly Patients with Refractory Hypertension. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7889024. [PMID: 35936366 PMCID: PMC9348927 DOI: 10.1155/2022/7889024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022]
Abstract
Refractory hypertension seriously affects the life safety of patients. To investigate the effect of carvedilol combined with conventional antihypertensive therapy on blood pressure, blood sugar, blood lipids, and cardiovascular and cerebrovascular complications in elderly patients with refractory hypertension, a total of 80 elderly patients with refractory hypertension who were admitted from June 2019 to September 2021 were selected as the retrospective research objects and divided into the observation group and the control group according to the random number table method, 40 cases in each group, and the control group received conventional antihypertensive therapy. On this basis, the observation group was treated with carvedilol, and the effects of blood pressure, blood sugar, blood lipids, and cardiovascular and cerebrovascular complications were analyzed in the two groups. After treatment, the systolic blood pressure, diastolic blood pressure, adrenal medulla (AM), and endothelin (ET) of the observation group were significantly lower than those of the control group, but the heart rate and NO of the observation group were significantly higher than those of the control group. After treatment, the fasting blood glucose, insulin, triacylglycerol (TG), cholesterol (CHO), and low-density lipoprotein (LDL-C) of the observation group were significantly higher than those of the control group, but the ISI and HDL-C of the observation group were significantly lower than those of the control group. After treatment, the levels of IL-1β, IL-6, TNF-α, UAER, BUN, and SCr in the observation group were significantly lower than those in the control group. The TC of the observation group was lower than that of the control group. Combination therapy has a remarkably stable, sustained, and safe antihypertensive effect on patients with refractory hypertension.
Collapse
Affiliation(s)
- Wen Zhang
- The First Hospital of Hunan University of Chinese Medicine, Department of Geriatrics, No. 95 Shaoshan Middle Road, Yuhua District, Changsha City, Hunan Province, China
| | - Guiming Deng
- The First Hospital of Hunan University of Chinese Medicine, Department of Geriatrics, No. 95 Shaoshan Middle Road, Yuhua District, Changsha City, Hunan Province, China
| | - Jia Hu
- Hunan University of Chinese Medicine, Graduate School, Xiangzui Road, Yuelu District, Changsha City, Hunan Province, China
| | - Ran Yan
- Hunan University of Chinese Medicine, School of Traditional Chinese Medicine, Xiangzui Road, Yuelu District, Changsha City, Hunan Province, China
| | - Junliu Hu
- Hunan University of Chinese Medicine, Graduate School, Xiangzui Road, Yuelu District, Changsha City, Hunan Province, China
| | - Jianmin Fan
- The First Hospital of Hunan University of Chinese Medicine, Department of Cardiovascular Diseases, No. 95 Shaoshan Middle Road, Yuhua District, Changsha City, Hunan Province, China
| |
Collapse
|
4
|
Is MVD the effective treatment for poorly controlled hypertension? J Clin Neurosci 2021; 86:20-25. [PMID: 33775328 DOI: 10.1016/j.jocn.2021.01.015] [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: 06/07/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies have shown that microvascular decompression (MVD) surgery could improve the clinical symptoms of hemifacial spasm (HFS) and decrease the blood pressure (BP) in patients with refractory hypertension. More positive long-term results are required to establish MVD as a treatment option for high blood pressure (HBP) and to refine the patient selection criteria. METHODS From October 2015 to September 2018, based on patient selection for cases with both HFS and poorly controlled HBP of nervous origin, MVD surgeries were performed on 12 patients aiming for better BP control. The patients were followed-up for at least 2 years. The surgical outcomes and associated factors were analyzed. RESULTS With respect to neurovascular compression (NVC) of facial nerve, the intra-operative findings concurred with pre-operative radiological findings except that in one case. Intra-operatively ipsilateral cranial nerve (CN) IX-X root exit zone (REZ) and rostral ventrolateral medulla (RVLM) NVCs were confirmed and concordant with pre-operative radiological findings in all 12 cases. 9 Of the 12 cases were completely free of facial spasm after surgery. 2 patients achieved partial relief. 1 patient still suffered from frequent facial spasm. 10 out of 12 patients achieved BP lowering after surgery. The BP of those 10 patients stayed at a relatively stable scale over the follow-up period. Although statistical significance was not obtained, for patients who are operated on the left side and those who have only 1 offensive artery, the surgery might lead to better BP control. CONCLUSIONS MVD is a safe and effective treatment for hypertension due to central nervous system (CNS) NVC in patients with both HBP and HFS. Further studies are required to examine long-term outcomes and establish criteria for patient selection.
Collapse
|
5
|
Niu X, Sun H, Yuan F, Chen X, Wei Z, Wang H, Ren J, Zhang J, Li W. Microvascular decompression in patients with hemifacial spasm. Brain Behav 2019; 9:e01432. [PMID: 31617334 PMCID: PMC6851818 DOI: 10.1002/brb3.1432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To study blood pressure alterations after microvascular decompression (MVD) surgery in patients with hemifacial spasm (HFS). METHODS A retrospective study was performed to review HFS patients who received MVD surgery between January 2014 and December 2016. Vessels that were considered to be responsible for HFS were determined by reviewing the brain magnetic resonance imaging, magnetic resonance angiography, and surgical video. Blood pressure measurements were performed 1 day before (preoperative) and 7 days after (postoperative) the MVD surgery. Pre- and postoperative blood pressure measurements were compared. RESULTS A total of 374 patients were included in the study, with 118 (31.6%) male patients, age 53.8 ± 9.9 years old, and 141 (37.7%) patients with hypertension. Systolic blood pressure had statistically significant decrease in patients with (134.5 ± 8.2-132.6 ± 9.1 mmHg, p = .01) or without (125.6 ± 9.1-123.8 ± 10.0 mmHg, p = .01) hypertension. Diastolic blood pressure only had statistically significant decrease in patients with hypertension (83.0 ± 5.8-82.0 ± 6.5 mmHg, p = .04). Analyses in all the study patients and in the subgroup of patients with hypertension showed that more statistically significant blood pressure reductions were observed when left-side vessel or vertebrobasilar artery was involved. CONCLUSION In patients with HFS, MVD not only decreased blood pressure in patients with hypertension but also affected blood pressure in patients without hypertension. Blood pressure reductions were more prominent when left-side vessel or vertebrobasilar artery was involved.
Collapse
Affiliation(s)
- Xuegang Niu
- Institution of Neurological Trauma and Repair, Characteristic Medical Center of the Chinese People's Armed Police Force, Tianjin, China.,Tianjin Fourth Central Hospital, Tianjin, China
| | - Hongtao Sun
- Institution of Neurological Trauma and Repair, Characteristic Medical Center of the Chinese People's Armed Police Force, Tianjin, China
| | - Fei Yuan
- Department of Radiology, Characteristic Medical Center of the Chinese People's Armed Police Force, Tianjin, China
| | - Xuyi Chen
- Institution of Neurological Trauma and Repair, Characteristic Medical Center of the Chinese People's Armed Police Force, Tianjin, China
| | - Zhengjun Wei
- Institution of Neurological Trauma and Repair, Characteristic Medical Center of the Chinese People's Armed Police Force, Tianjin, China
| | - Hang Wang
- Institution of Neurological Trauma and Repair, Characteristic Medical Center of the Chinese People's Armed Police Force, Tianjin, China
| | - Jibin Ren
- Institution of Neurological Trauma and Repair, Characteristic Medical Center of the Chinese People's Armed Police Force, Tianjin, China
| | - Jian Zhang
- Institution of Neurological Trauma and Repair, Characteristic Medical Center of the Chinese People's Armed Police Force, Tianjin, China
| | - Weixin Li
- Logistics College of the Chinese People's Armed Police Force, Tianjin, China
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Sosa P, Dujovny M, Onyekachi I, Sockwell N, Cremaschi F, Savastano LE. Microvascular anatomy of the cerebellar parafloccular perforating space. J Neurosurg 2016; 124:440-9. [DOI: 10.3171/2015.2.jns142693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The cerebellopontine angle is a common site for tumor growth and vascular pathologies requiring surgical manipulations that jeopardize cranial nerve integrity and cerebellar and brainstem perfusion. To date, a detailed study of vessels perforating the cisternal surface of the middle cerebellar peduncle—namely, the paraflocculus or parafloccular perforating space—has yet to be published. In this report, the perforating vessels of the anterior inferior cerebellar artery (AICA) in the parafloccular space, or on the cisternal surface of the middle cerebellar peduncle, are described to elucidate their relevance pertaining to microsurgery and the different pathologies that occur at the cerebellopontine angle.
METHODS
Fourteen cadaveric cerebellopontine cisterns (CPCs) were studied. Anatomical dissections and analysis of the perforating arteries of the AICA and posterior inferior cerebellar artery at the parafloccular space were recorded using direct visualization by surgical microscope, optical histology, and scanning electron microscope. A comprehensive review of the English-language and Spanish-language literature was also performed, and findings related to anatomy, histology, physiology, neurology, neuroradiology, microsurgery, and endovascular surgery pertaining to the cerebellar flocculus or parafloccular spaces are summarized.
RESULTS
A total of 298 perforating arteries were found in the dissected specimens, with a minimum of 15 to a maximum of 26 vessels per parafloccular perforating space. The average outer diameter of the cisternal portion of the perforating arteries was 0.11 ± 0.042 mm (mean ± SD) and the average length was 2.84 ± 1.2 mm. Detailed schematics and the surgical anatomy of the perforating vessels at the CPC and their clinical relevance are reported.
CONCLUSIONS
The parafloccular space is a key entry point for many perforating vessels toward the middle cerebellar peduncle and lateral brainstem, and it must be respected and protected during surgical approaches to the cerebellopontine angle.
Collapse
Affiliation(s)
- Pablo Sosa
- 1Department of Neuroscience, Clinical and Surgical Neurology, School of Medicine, National University of Cuyo, Mendoza, Argentina
| | - Manuel Dujovny
- 2Departments of Neurosurgery and Electrical Engineering, Wayne State University, Detroit; and
| | - Ibe Onyekachi
- 2Departments of Neurosurgery and Electrical Engineering, Wayne State University, Detroit; and
| | - Noressia Sockwell
- 2Departments of Neurosurgery and Electrical Engineering, Wayne State University, Detroit; and
| | - Fabián Cremaschi
- 1Department of Neuroscience, Clinical and Surgical Neurology, School of Medicine, National University of Cuyo, Mendoza, Argentina
| | - Luis E. Savastano
- 3Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|