Microvascular decompression in the treatment of hypertension: review and update.
BACKGROUND
Neurogenic hypertension in association with vascular compression of the left rostral ventrolateral medulla has been documented. A recent group of these clinical reports has raised great interest in decompression of this area of the brainstem as a definitive therapy for essential hypertension.


METHODS
To further clarify the mechanism by which decompression of the left rostral ventrolateral medulla relieves neurogenic hypertension, we describe in detail the basic science, animal models, human studies, and most recent clinical trials regarding surgical decompression of this area.


CONCLUSIONS
Multi-disciplinary evidence supports the hypothesis that a sub-population of hypertensive patients achieve significant relief of their hypertension after microvascular decompression. A multi-institutional, prospective, randomized study is necessary to determine the efficacy of microvascular decompression for neurogenic hypertension.
Levy
E I
EI
Department of Neurosurgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213-2582, USA.
Scarrow
A M
AM
Jannetta
P J
PJ
D001488:Basilar Artery / Q000601:surgery; D019299:Decompression, Surgical; D020435:Glossopharyngeal Nerve Diseases / Q000209:etiology / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000601:surgery*; D008526:Medulla Oblongata / Q000098:blood supply*; D008866:Microsurgery; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000601:surgery*; D020421:Vagus Nerve Diseases / Q000209:etiology / Q000601:surgery; D014711:Vertebral Artery / Q000601:surgery