Neurovascular pulsatile compression and neurosurgical decompression of the rostral ventrolateral medulla in medically resistant hypertensive patients.
OBJECTIVE
In cases of severe primary hypertension not responding to conventional medical therapy, neurovascular pulsatile compression of the rostral ventrolateral medulla on the left side may be considered as an etiological factor in the hypertension. Through neurosurgical decompression, the blood pressure can be reduced in these cases, and the conventional medication can also become more effective.


METHODS
The authors retrospectively analysed the changes in the blood pressure and therapy of patients with or without neurosurgical decompression over a 2-year period. The 2-year data were available for 9 operated and 7 non-operated patients with neurovascular compression. The data of control examinations performed 1, 3, 6, 12 and 24 months after the intervention (or after MR-angiography in the non-operated cases) were analysed.


RESULTS
After the decompression, both the systolic and diastolic blood pressure decreased significantly and permanently in all cases, and there was an improved response to the medication. In the non-operated group, the blood pressure did not change significantly during the 2 years.


CONCLUSIONS
In severe hypertension that does not respond to conventional therapy, neurosurgical decompression of the brain stem on the left side can guarantee a long-lasting blood pressure reduction and a better response to antihypertensive medication.
Legrady
Peter
P
First Department of Medicine, University of Szeged, Szeged, Hungary. peter.legrady@freemail.hu
Voros
Erika
E
Bajcsi
Dora
D
Sonkodi
Sandor
S
Barzo
Pal
P
Abraham
Gyorgy
G
D000792:Angiography; D001794:Blood Pressure; D001933:Brain Stem; D016022:Case-Control Studies; D019299:Decompression, Surgical; D003971:Diastole; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008526:Medulla Oblongata / Q000503:physiopathology / Q000601:surgery*; D009408:Nerve Compression Syndromes / Q000601:surgery*; D012189:Retrospective Studies; D013599:Systole