Microvascular decompression of the left lateral medulla oblongata for severe refractory neurogenic hypertension.
OBJECTIVE
To demonstrate that microvascular decompression of the left medulla oblongata is a safe and effective modality for treating elevated blood pressure in patients with severe medically refractory "essential" hypertension (HTN).


METHODS
Twelve patients with medically intractable HTN with or without autonomic dysreflexia underwent microvascular decompression of the left rostral ventrolateral medulla oblongata. Causes such as pheochromocytoma, carcinoid syndrome, and renal disease were ruled out before surgery. Indications for surgery included systolic blood pressures greater than 180 mm Hg refractory to three or more medications, severe blood pressure lability, or medically resistant HTN at systolic pressures greater than 160 mm Hg associated with autonomic dysreflexia and/or magnetic resonance images demonstrating left medullary compression. The median age and follow-up duration were 51 years and 4.1 years, respectively.


RESULTS
Ten of 12 patients experienced reductions in systolic blood pressure greater than 20 mm Hg. Of these 10 patients, pressure reductions were temporary (6 mo) in two. Seven of eight patients experienced improvement in blood pressure lability and/or autonomic dysreflexia, with five patients showing sustained improvements.


CONCLUSIONS
Microvascular decompression of the left rostral ventrolateral medulla oblongata may be an effective treatment modality for patients suffering from severe HTN and/or autonomic dysreflexia refractory to medical management.
Levy
E I
EI
Department of Neurological Surgery, The University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
Clyde
B
B
McLaughlin
M R
MR
Jannetta
P J
PJ
D000328:Adult; D000368:Aged; D001158:Arteries / Q000503:physiopathology / Q000601:surgery; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology; D002531:Cerebellum / Q000098:blood supply; D019299:Decompression, Surgical / Q000379:methods*; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000503:physiopathology / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology; D012021:Reflex, Abnormal / Q000502:physiology; D012189:Retrospective Studies; D013564:Sympathetic Nervous System / Q000503:physiopathology; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000503:physiopathology / Q000601:surgery