Hypertension of neurogenic origin: effect of microvascular decompression of the CN IX-X root entry/exit zone and ventrolateral medulla on blood pressure in a prospective series of 48 patients with hemifacial spasm associated with essential hypertension

Restricted access

OBJECT

In spite of solid anatomical and physiological arguments and the promising results of Jannetta in the 1970s, treating essential hypertension by microvascular decompression (MVD) of the brainstem has not gained acceptance as a mainstream technique. The main reason has been a lack of established selection criteria. Because of this, the authors' attempts have been limited to patients referred for MVD for hemifacial spasm (HFS) who also had hypertension likely to be related to neurovascular compression (NVC).

METHODS

Of 201 patients referred for HFS, 48 (23.8%) had associated hypertension. All had high-resolution MR images that demonstrated NVC. All underwent MVD of the root exit/entry zone (REZ) of the ninth and tenth cranial nerves (CN IX-X) and adjacent ventrolateral medulla in addition to the CN VII REZ. Effects on hypertension, graded using the WHO classification, were studied up to the latest follow-up, which was 2–16 years from the time of surgery, 7 years on average. Also, effects of MVD on blood pressure (BP) according to the side of vascular compression were evaluated.

RESULTS

Preoperatively, hypertension was severe in all but 1 of the patients; in spite of medical treatment, 47 patients still had WHO Grade 1 or 2 hypertension, and 18 still had unstable BP. After MVD, at latest follow-up, BP had returned to normal (i.e., systolic pressure < 140 mm Hg) in 28 patients; 14 of these patients (29.10% of the whole series) were able to maintain normal BP without any antihypertensive treatment; the other 14 still required some medication to maintain their BP below 140 mm Hg (p < 0.0001). Also, at latest follow-up, BP remained unstable in only 8 of the 18 patients with instability prior to MVD (p < 0.02). Analysis according to side of compression showed that of the 30 patients with left-sided compression, 17 had their BP normalized (without medication in 11 cases), and of the 18 patients with right-sided compression, 11 had their BP normalized (without medication in 3 cases). The difference between sides was not significant.

CONCLUSIONS

These results argue for considering MVD for the treatment of hypertension likely to be due to NVC at the CN IX-X REZ and adjacent ventrolateral medulla. Criteria for selecting patients with hypertension alone still need to be established and could include the following indications: apparently essential hypertension, likely to be neurogenic, in patients in whom high-resolution MRI shows clear-cut images of NVC at the CN IX-X REZ and adjacent ventrolateral medulla and in whom BP cannot be controlled by medical treatment.

ABBREVIATIONSAICA = anterior inferior cerebellar artery; BA = basilar artery; BP = blood pressure; CN = cranial nerve; ENMG = electroneuromyographic; GP = general practitioner; HFS = hemifacial spasm; MVD = microvascular decompression; NVC = neurovascular compression; PICA = posterior inferior cerebellar artery; REZ = root entry/exit zone; VA = vertebral artery.
Article Information

Contributor Notes

Correspondence Marc Sindou, Department of Neurosurgery, University of Lyon 1, Hôpital Neurologique “Pierre Wertheimer,” Groupement Hospitallier EST, 59 Blvd. Pinel, Lyon 69003, France. email: marc.sindou@chu-lyon.fr.INCLUDE WHEN CITING Published online July 31, 2015; DOI: 10.3171/2014.12.JNS141775.DISCLOSURE The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Headings
References
  • 1

    Akimura TFurutani YJimi YSaito KKashiwagi SKato S: Essential hypertension and neurovascular compression at the ventrolateral medulla oblongata: MR evaluation. AJNR Am J Neuroradiol 16:4014051995

    • Search Google Scholar
    • Export Citation
  • 2

    Alexander RS: Tonic and reflex functions of medullary sympathetic cardiovascular centers. J Neurophysiol 9:2052171946

  • 3

    Amendt KCzachurski JDembrowsky KSeller H: Bulbospinal projections to the intermediolateral cell column: a neuroanatomical study. J Auton Nerv Syst 1:1031071979

    • Search Google Scholar
    • Export Citation
  • 4

    Armstrong DMRoss CAPickel VMJoh THReis DJ: Distribution of dopamine-, noradrenaline-, and adrenaline-containing cell bodies in the rat medulla oblongata: demonstrated by the immunocytochemical localization of catecholamine biosynthetic enzymes. J Comp Neurol 212:1731871982

    • Search Google Scholar
    • Export Citation
  • 5

    Barker FG IIJannetta PJBissonette DJShields PTLarkins MVJho HD: Microvascular decompression for hemifacial spasm. J Neurosurg 82:2012101995

    • Search Google Scholar
    • Export Citation
  • 6

    Blessing WWSved AFReis DJ: Arterial pressure and plasma vasopressin: regulation by neurons in the caudal ventrolateral medulla of the rabbit. Clin Exp Hypertens A 6:1491561984

    • Search Google Scholar
    • Export Citation
  • 7

    Boogaarts HDMenovsky Tde Vries JVerbeek ALMLenders JWGrotenhuis JA: Primary hypertension and neurovascular compression: a meta-analysis of magnetic resonance imaging studies. J Neurosurg 116:1471562012

    • Search Google Scholar
    • Export Citation
  • 8

    Caverson MMCiriello JCalaresu FR: Cardiovascular afferent inputs to neurons in the ventrolateral medulla projecting directly to the central autonomic area of the thoracic cord in the cat. Brain Res 274:3543581983

    • Search Google Scholar
    • Export Citation
  • 9

    Caverson MMCiriello JCalaresu FR: Direct pathway from cardiovascular neurons in the ventrolateral medulla to the region of the intermediolateral nucleus of the upper thoracic cord: an anatomical and electrophysiological investigation in the cat. J Auton Nerv Syst 9:4514751983

    • Search Google Scholar
    • Export Citation
  • 10

    Ceral JZizka JEliás PSolar MKlzo LReissigová J: Neurovascular compression in essential hypertension: cause, consequence or unrelated finding?. J Hum Hypertens 21:1791812007

    • Search Google Scholar
    • Export Citation
  • 11

    Ciriello JCaverson MM: Bidirectional cardiovascular connections between ventrolateral medulla and nucleus of the solitary tract. Brain Res 367:2732811986

    • Search Google Scholar
    • Export Citation
  • 12

    Colón GPQuint DJDickinson LDBrunberg JAJamerson KAHoff JT: Magnetic resonance evaluation of ventrolateral medullary compression in essential hypertension. J Neurosurg 88:2262311998

    • Search Google Scholar
    • Export Citation
  • 13

    Colosimo CChianese MRomano SDella Chiara VVanacore N: Hemifacial spasm: a clinical and epidemiological study. Mov Disord 17:523552362002

    • Search Google Scholar
    • Export Citation
  • 14

    Colosimo CChianese MRomano SVanacore N: Is hypertension associated with hemifacial spasm?. Neurology 61:5872003. (Letter)

  • 15

    Dahlström AFuxe K: Evidence for the existence of monoamine-containing neurons in the central nervous system. I. Demonstration of monoamines in the cell bodies of brainstem neurons. Acta Physiol Scand Suppl 232:1551964

    • Search Google Scholar
    • Export Citation
  • 16

    Dampney RALGoodchild AKTan E: Vasopressor neurons in the rostral ventrolateral medulla of the rabbit. J Auton Nerv Syst 14:2392541985

    • Search Google Scholar
    • Export Citation
  • 17

    Defazio GBerardelli AAbbruzzese GCoviello VDe Sal-via RFederico F: Primary hemifacial spasm and arterial hypertension: a multicenter case-control study. Neurology 54:119812002000

    • Search Google Scholar
    • Export Citation
  • 18

    Dittmar C: Ueber die Lage des Sogenannten Gefässcentrums in der Medulla ablongata. Berichte ueber die Verhandlungen der saechsischen Gesellschaft der Wissenschaften zu Leipzig. Mathematisch Physikalische Klasse Leipzig 25:4494691873

    • Search Google Scholar
    • Export Citation
  • 19

    European Society of Hypertension/European Society of Cardiology Hypertension Guidelines Committee: Practice guidelines for primary care physician: 2003 ESH/ESC hypertension guidelines. J Hypertens 21:117911862003

    • Search Google Scholar
    • Export Citation
  • 20

    Geiger HNaraghi RSchobel HPFrank HSterzel RBFahlbusch R: Decrease of blood pressure by ventrolateral medullary decompression in essential hypertension. Lancet 352:4464491998

    • Search Google Scholar
    • Export Citation
  • 21

    Giuffrida SDe Luca SLanza SPapotto MRestivo DATomarchio L: Ipertensione arteriosa e compressione vascolare sul bulbo. Riv Neurobiol 44:2953001998

    • Search Google Scholar
    • Export Citation
  • 22

    Granata ARRuggiero DAPark DHJoh THReis DJ: Lesions of epinephrine neurons in the rostral ventrolateral medulla abolish the vasodepressor components of baroreflex and cardiopulmonary reflex. Hypertension 5:V80V841983

    • Search Google Scholar
    • Export Citation
  • 23

    Hökfelt TFuxe KGoldstein MJohansson O: Immunohistochemical evidence for the existence of adrenaline neurons in the rat brain. Brain Res 66:2352511974

    • Search Google Scholar
    • Export Citation
  • 24

    Hohenbleicher HSchmitz SAKoennecke HCOffermann ROffermann JZeytountchian H: Neurovascular contact of cranial nerve IX and X root-entry zone in hypertensive patients. Hypertension 37:1761812001

    • Search Google Scholar
    • Export Citation
  • 25

    Howe PR: Blood pressure control by neurotransmitters in the medulla oblongata and spinal cord. J Auton Nerv Syst 12:951151985

  • 26

    Jannetta PJGendell HM: Clinical observations on etiology of essential hypertension. Surg Forum 30:4314321979

  • 27

    Jannetta PJSegal RWolfson SK Jr: Neurogenic hypertension: etiology and surgical treatment. I. Observations in 53 patients. Ann Surg 201:3913981985

    • Search Google Scholar
    • Export Citation
  • 28

    Johnson DColey SCBrown JMoseley IF: The role of MRI in screening for neurogenic hypertension. Neuroradiology 42:991032000

  • 29

    Kleineberg BBecker HGaab MRNaraghi R: Essential hypertension associated with neurovascular compression: angiographic findings. Neurosurgery 30:8348411992

    • Search Google Scholar
    • Export Citation
  • 30

    Leal PRHermier MFroment JCSouza MACristino-Filho GSindou M: Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 152:8178252010

    • Search Google Scholar
    • Export Citation
  • 31

    Leal PRHermier MSouza MACristino-Filho GFroment JCSindou M: Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: a prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Neurosurgery 69:15262011

    • Search Google Scholar
    • Export Citation
  • 32

    Levy EIClyde BMcLaughlin MRJannetta PJ: Microvascular decompression of the left lateral medulla oblongata for severe refractory neurogenic hypertension. Neurosurgery 43:191998

    • Search Google Scholar
    • Export Citation
  • 33

    Levy EIScarrow AMJannetta PJ: Microvascular decompression in the treatment of hypertension: review and update. Surg Neurol 55:2112001

    • Search Google Scholar
    • Export Citation
  • 34

    Møller ARMøller MB: Does intraoperative monitoring of auditory evoked potentials reduce incidence of hearing loss as a complication of microvascular decompression of cranial nerves?. Neurosurgery 24:2572631989

    • Search Google Scholar
    • Export Citation
  • 35

    Morimoto SSasaki SMiki SKawa TItoh HNakata T: Neurovascular compression of the rostral ventrolateral medulla related to essential hypertension. Hypertension 30:77821997

    • Search Google Scholar
    • Export Citation
  • 36

    Morise THorita MKitagawa IShinzato RHoshiba YMasuya H: The potent role of increased sympathetic tone in pathogenesis of essential hypertension with neurovascular compression. J Hum Hypertens 14:8078112000

    • Search Google Scholar
    • Export Citation
  • 37

    Nakamura TOsawa MUchiyama SIwata M: Arterial hypertension in patients with left primary hemifacial spasm is associated with neurovascular compression of the left rostral ventrolateral medulla. Eur Neurol 57:1501552007

    • Search Google Scholar
    • Export Citation
  • 38

    Naraghi RFahlbusch R: Microvascular decompression for the treatment of hypertension. Oper Tech Neurosurg 4:1531612001

  • 39

    Naraghi RGeiger HCrnac JHuk WFahlbusch REngels G: Posterior fossa neurovascular anomalies in essential hypertension. Lancet 344:146614701994

    • Search Google Scholar
    • Export Citation
  • 40

    Oliveira LDCardoso FVargas AP: Hemifacial spasm and arterial hypertension. Mov Disord 14:8328351999

  • 41

    Polo GFischer CSindou MPMarneffe V: Brainstem auditory evoked potential monitoring during microvascular decompression for hemifacial spasm: intraoperative brainstem auditory evoked potential changes and warning values to prevent hearing loss—prospective study in a consecutive series of 84 patients. Neurosurgery 54:971062004

    • Search Google Scholar
    • Export Citation
  • 42

    Reis DJRoss CARuggiero ARGranata ARJoh TH: Role of adrenaline neurons of the ventro-lateral medullai (the CI group) in the tonic and phasic control of arterial pressure. Clin Exper Hypertens A 6:2212411984

    • Search Google Scholar
    • Export Citation
  • 43

    Ross CARuggiero DAJoh THPark DHReis DJ: Adrenaline synthesizing neurons in the rostral ventrolateral medulla: a possible role in tonic vasomotor control. Brain Res 273:3563611983

    • Search Google Scholar
    • Export Citation
  • 44

    Ross CARuggiero DAReis DJ: Projections from the nucleus tractus solitarii to the rostral ventrolateral medulla. J Comp Neurol 242:5115341985

    • Search Google Scholar
    • Export Citation
  • 45

    Säglitz SAGaab MR: Investigations using magnetic resonance imaging: is neurovascular compression present in patients with essential hypertension?. J Neurosurg 96:100610122002

    • Search Google Scholar
    • Export Citation
  • 46

    Sauvain MOMagistris MRde Tribolet N: Microvascular decompression of the facial nerve. Oper Tech Neurosurg 4:1271362001

  • 47

    Segal RGendell HMCanfield DDujovny MJannetta PJ: Cardiovascular response to pulsatile pressure applied to ventrolateral medulla. Surg Forum 30:4334351979

    • Search Google Scholar
    • Export Citation
  • 48

    Segal RGendell HMCanfield DDujovny MJannetta PJ: Hemodynamic changes induced by pulsatile compression of the ventrolateral medulla. Angiology 33:1611721982

    • Search Google Scholar
    • Export Citation
  • 49

    Segal RJannetta PJWolfson SK JrDujovny MCook EE: Implanted pulsatile balloon device for simulation of neurovascular compression syndromes in animals. J Neurosurg 57:6466501982

    • Search Google Scholar
    • Export Citation
  • 50

    Sendeski MMConsolim-Colombo FMKrieger EMda Costa Leite C: The spectrum of magnetic resonance imaging findings in hypertension-related neurovascular compression. Neuroradiology 48:21252006

    • Search Google Scholar
    • Export Citation
  • 51

    Sindou M: Is there a place for microsurgical vascular decompression of the brainstem for apparent essential blood hypertension?. a review Adv Tech Stand Neurosurg 42:69762015

    • Search Google Scholar
    • Export Citation
  • 52

    Sindou MLeston JDecullier EChapuis F: Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg 107:114411532007

    • Search Google Scholar
    • Export Citation
  • 53

    Sindou MLeston JHoweidy TDecullier EChapuis F: Microvascular decompression for primary trigeminal neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochir (Wien) 148:123512452006

    • Search Google Scholar
    • Export Citation
  • 54

    Sindou MP: Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring. Acta Neurochir (Wien) 147:101910262005

    • Search Google Scholar
    • Export Citation
  • 55

    Smith PAMeaney JFGraham LNStoker JBMackintosh AFMary DA: Relationship of neurovascular compression to central sympathetic discharge and essential hypertension. J Am Coll Cardiol 43:145314582004

    • Search Google Scholar
    • Export Citation
  • 56

    Tan EKChan LLLum SYKoh PHan SYFook-Chong SM: Is hypertension associated with hemifacial spasm?. Neurology 60:3433442003

    • Search Google Scholar
    • Export Citation
  • 57

    Thuerl CRump LCOtto MWinterer JTSchneider BFunk L: Neurovascular contact of the brain stem in hypertensive and normotensive subjects: MR findings and clinical significance. AJNR Am J Neuroradiol 22:4764802001

    • Search Google Scholar
    • Export Citation
  • 58

    Watters MRBurton BSTurner GECannard KR: MR screening for brain stem compression in hypertension. AJNR Am J Neuroradiol 17:2172211996

    • Search Google Scholar
    • Export Citation
  • 59

    Whithworth JA: World Health Organization: International Society of Hypertension Writing Group: World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 21:198319922003

    • Search Google Scholar
    • Export Citation
  • 60

    Zanchetti A: Guidelines for the management of hypertension: the World Health Organization/International Society of Hypertension. J Hypertens Suppl 13S119S1221995

    • Search Google Scholar
    • Export Citation
  • 61

    Zizka JCeral JElias PTintera JKlzo LSolar M: Vascular compression of rostral medulla oblongata: prospective MR imaging study in hypertensive and normotensive subjects. Radiology 230:65692004

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 436 342 9
PDF Downloads 342 267 8
EPUB Downloads 0 0 0
PubMed
Google Scholar