Long-lasting improvement of arterial hypertension after surgical treatment of a foramen magnum meningioma: case report.
BACKGROUND
Neurogenic arterial hypertension has been proposed to be caused by neurovascular compression in many cases. However, there is little reference to tumors causing hypertension by local compression of the vagal nerve or the ventrolateral medulla oblongata. The following case illustrates the effects of surgery for a meningioma of the foramen magnum on arterial hypertension.


METHODS
A 54-year-old woman suffered from arterial hypertension for at least 7 months, for which she required a combined medical treatment regime. She suffered for 6 months from dizziness and tinnitus, more in the left ear than in the right. Neurologic examination revealed a horizontal fixation nystagmus and a mild left-sided hearing loss. Magnetic resonance imaging and computed tomographic angiography showed a contrast-enhancing tumor on the left side of the foramen magnum compressing the medulla oblongata close to the vertebral artery and vascularized by branches of the left PICA. Complete surgical extirpation was performed using a medial craniocervical approach. The tinnitus and dizziness were gone and hearing improved. Postoperatively, the arterial hypertension showed a long-lasting improvement (observation period 8 months) with only minimal medical treatment.


CONCLUSIONS
Based on our case, we conclude that tumors in close proximity to the ventrolateral medulla oblongata may induce neurogenic hypertension, similar to neurovascular compression.
Wörner
Bertold Andreas
BA
Neurosurgical Department, Klinikum Villingen-Schwenningen, Germany.
Rahim
Tamim
T
Lange
Manfred
M
Fink
Ulrich
U
Oeckler
Reinhard
R
D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D005539:Foramen Magnum / Q000473:pathology / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008526:Medulla Oblongata / Q000473:pathology / Q000601:surgery; D008577:Meningeal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D020421:Vagus Nerve Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery