Decrease of blood pressure by ventrolateral medullary decompression in essential hypertension

• Published in: The Lancet (British edition) 1998-08, Vol.352 (9126), p.446-449
• Main Authors: Geiger, H, Naraghi, R, Schobel, HP, Frank, H, Sterzel, RB, Fahlbusch, R
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blood Pressure; Blood Vessel Prosthesis; Cerebral Arteries - surgery; Decompression, Surgical - methods; Female; Glossopharyngeal Nerve; Humans; Hypertension; Hypertension - diagnosis; Hypertension - surgery; Magnetic Resonance Angiography; Male; Medical sciences; Medulla Oblongata - blood supply; Medulla Oblongata - surgery; Microsurgery - methods; Middle Aged; Nerve Compression Syndromes - surgery; Prospective Studies; Pulsatile Flow; Side effects; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vagus Nerve; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(97)11343-5

About 20% of adults worldwide will develop hypertension. Studies and clinical observations suggest an association between hypertension and pulsatile compression of the ventrolateral medulla oblongata by a looping artery. We investigated whether neurosurgical microvascular decompression substantially decreases blood pressure long-term in patients with severe essential hypertension. We included eight patients who had received three or more antihypertensive drugs without adequate control of blood pressure, intolerable side-effects, or both. All patients underwent microvascular decompression at the root-entry zone of cranial nerves IX and X after neurovascular compression of the ventrolateral medulla oblongata was seen on magnetic-resonance angiography. 3 months after surgery, blood pressure and antihypertensive regimens had decreased substantially in three patients. Four patients who were followed up for more than 1 year became normotensive, but their antihypertensive regimens remained the same as those at 3 months. One patient did not improve. No complications associated with decompression occurred. One patient experienced a transient vocal-cord paresis after the laryngeal part of the vagus nerve was manoeuvered during surgery. We showed a direct causal relation between raised blood pressure and irritation of cranial nerves IX and X. A subgroup of patients with essential hypertension may exist who have secondary forms of hypertension related to neurovascular compression at the ventrolateral medulla and who may be successfully treated with decompression.