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Abstract
PurposeControversy exists on the association of arterial hypertension (HTN) and neurovascular compression (NVC) at the ventrolateral medulla (VLM). No standardized and reproducible technique has been introduced yet for detection of NVC in HTN. This study aimed to generate, analyze and compare different results of exact reproducible anatomical 3D-representations of the VLM in patients with HTN, based on magnetic resonance imaging (MRI).MethodsA 3T scanner provided MRI (T2-constructive interference in steady state (CISS) high resolution imaging and three-dimensional Time-of-flight (3D-TOF) angiography) from the posterior fossa of 44 patients with clinical treatment-resistant HTN. Image processing consists of segmentation of the CISS data, registration and fusion of the CISS and TOF data and visualization. For each patient two 3D-visualizations (before and after fusion) were obtained. The reproduction quality of the vessels, flow-related signal variability and pulsation artifacts were analyzed and compared, using a ranking score.ResultsIntegrating vascular information from TOF into CISS data reduced artifacts in 3D-visualizations of exclusively processed CISS data. The quality of 3D-visualization of the vessels near the brain stem was significantly improved (p = 0.004). The results were reproducible and reliable. The quality of the 3D-presentations of neurovascular relationships at the VLM improved significantly (p < 0.001).ConclusionThe 3D-visualization of fused image data provides an excellent overview of the relationship between cranial nerves and vessels at the VLM and simplifies the detection of NVC in HTN. It provides a powerful tool for future clinical and scientific research. Although microvascular decompression (MVD) in treatment resistant HTN is not a standard procedure, it can be discussed in selected patients with intractable severe HTN.
Highlights
Material and MethodsJannetta et al [1] suggested an association between essential hypertension (HTN) and neurovascular compression (NVC) at the ventrolateral medulla (VLM) [1]
In 1985 they published the results after microvascular decompression (MVD) of the VLM in a series of 42 patients suffering from HTN
This study presents for the first time a highly precise 3D-visualization of the VLM in patients with essential HTN and with a special emphasis on depiction of the root entry zone (REZ) of cranial nerves (CN) IX
Summary
Material and MethodsJannetta et al [1] suggested an association between essential hypertension (HTN) and neurovascular compression (NVC) at the ventrolateral medulla (VLM) [1]. In 1985 they published the results after microvascular decompression (MVD) of the VLM in a series of 42 patients suffering from HTN He reported a significant reduction of blood pressure up to normalization in 75% almost corresponding to success rates of other hyperactive cranial nerve dysfunctions [1]. The higher signal of 3 T can improve the spatial resolution for the assessment of NVC [16]
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