Microvascular decompression for the treatment of neurogenic hypertension with trigeminal neuralgia

Wenchao Lu,Yuangang Wang,Hui Wang,Zhongnan Yan,Hongmin Che

doi:10.1186/s12883-019-1569-y

Abstract

BackgroundTo evaluate the efficacy of microvascular decompression (MVD) in reducing hypertension (HTN) in hypertensive patients with trigeminal neuralgia (TN).MethodsThe clinical data of 58 cases of neurogenic HTN with TN treated in our hospital were retrospectively reviewed. Preoperative MR revealed abnormal blood pressure in the left rostral ventrolateral medulla (RVLM) and the posterior cranial nerve root entry zone (REZ). The patients were divided into control group: only trigeminal nerve was treated with MVD; experimental group: trigeminal nerve, RVLM and REZ were treated with MVD at the same time. The patients were followed up for 6 months to 1 year to observe the changes of blood pressure.ResultsThere was no significant difference in gender, age, course of TN, course of HTN, grade of HTN and preoperative blood pressure between the two groups. After operation, the effective rate of HTN improvement with MVD was 32.1% in the control group. There was no significant difference in the preoperative and post operative blood pressure. (P△SBP = 0.131; P△BDP = 0.078). In the experimental group, the effective rate was 83.3%. The postoperative blood pressure was significantly lower than preoperative values. (P△SBP < 0.001; P△DBP < 0.001).ConclusionsMVD is an effective treatment for neurogenic HTN. However, the criteria for selecting hypertensive patients who need MVD to control their HTN still needs to be further determined. Possible indications may include: left trigeminal neuralgia, neurogenic HTN; abnormal blood pressure compression in the left RVLM and REZ areas on MR; and blood pressure in these patients can not be effectively controlled by drugs.

Highlights

To evaluate the efficacy of microvascular decompression (MVD) in reducing hypertension (HTN) in hypertensive patients with trigeminal neuralgia (TN)
There were no significant differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) between the preoperative and the 12 months after surgery in the control group
In 1979, Jannetta et al [2] found that part of HTN was caused by abnormal arterial compression of the left rostral ventrolateral medulla (RVLM) and root entry zone (REZ) area, which was called neurogenic HTN

Summary

Introduction

To evaluate the efficacy of microvascular decompression (MVD) in reducing hypertension (HTN) in hypertensive patients with trigeminal neuralgia (TN). With the improvement of people’s living standards and the aging of our society, HTN is one of the diseases that seriously threaten human health, its incidence is increasing year by year. If there is no effective treatment, it often leads to serious complications and even death [1]. Most patients with HTN can get ideal control of blood pressure through systematic and regular medication. Some patients still have difficulty to effectively control blood pressure after. Lu et al BMC Neurology (2019) 19:341

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Conclusion