Effect of microvascular decompression on blood pressure in the treatment of hypertensive patients with cerebral nerve disorders

Abstract

Objective To explore the effect of microvascular decompression (MVD) on blood pressure in the treatment of hypertensive patients with cerebral nerve disorders and the value of preoperative MRI examination for the operation. Methods From January 2015 to October 2016, 72 hypertensive patients with cerebral nerve disorders were admitted to Department of Neurosurgery, the Affiliated Hospital of Southwest Medical University and enrolled into this retrospective study. We evaluated the relationship between vessels and rostral ventrolateral medulla (RVLM) in the surgical side before operation by 3 dimensional time of flight magnetic resonance angiography (3D-TOF-MRA). Thirty cases underwent MVD of the root exit/entry zone (REZ) of the related cerebral nerves (group A) and the other 42 cases underwent exploration of RVLM or MVD of RVLM in addition to the related cerebral nerves (group B). In group B, 32 cases received MVD of RVLM (group C) and the other 10 cases merely received exploration of RVLM (group D). The positive rate of preoperative MRI examination was compared between two sides. SBP (systolic blood pressure) and DBP (diastolic blood pressure) prior to operation and 12 months after operation were monitored, and the operative efficiency was evaluated. Results For preoperative MRI examination, the positive rate on the left and right sides was 87.5% (35/40) and 65.6% (21/32), respectively, which was was significantly higher on the left side than the right (P=0.027). The sensitivity, specificity and accuracy of 3D-TOF-MRA were respectively 85.7% (30/35), 71.4% (5/7) and 83.3% (35/42). The differences between preoperative and postoperative blood pressures were not statistically significant in group A (PSBP=0.067, PDBP=0.184), while they were statistically significant in group C (left side: PSBP<0.01, PDBP<0.01; right side: PSBP<0.01, PDBP<0.01). The differences of △BP (blood pressure change) (P△SBP=0.425, P△DBP=0.065) and operative efficiency(P=0.703) between left side and right side were not statistically significant in group C. Conclusions MVD seems effective in treatment of neurogenic hypertension, and there is no significant difference in the therapeutic effect between left side and right side. MRI examination could be helpful for the diagnosis of neurogenic hypertension. Key words: Hypertension; Neurosurgical procedures; Treatment outcome; Microvascular decompression; Magnetic resonance imaging