Therapeutic effect of left medullary microvascular decompression on primary hypertension

Abstract

Objective To explore the clinical effect of left medullary microvascular decompression (MVD) on primary hypertension complicated by cerebral hematoma and cranial nerve disease. Methods After left cerebral hematomas in 26 patients and cerebellar hematomas in 2 patients were evacuated, left medullary MVD was performed via suboccipital retromastoidal approach. Fifteen of them were operated emergently. Eight hypertensive patients complicated by cranial nerve diseases (4trigeminal neuralgia, 1 glossopharyngeal neuralgia, 2 acoustic neuroma, 1 trigeminal neuroma) underwent left medullary MVD after the planned cranial nerve MVD and tumor resection. Blood pressure was monitored and the variety and dosage changes of anti-hypertension were recorded. Results Vessel loops that compressed, contacted or transfixed the medulla oblongata and vagus nerve root entry zone (REZ) were found in all patients. The offending vessel loops included posterior inferior cerebellar artery (PICA, n=20), vertebral artery (VA, n=11), and anterior inferior cerebellar artery (AICA, n=5). The relationship between the offending vessel loops and medulla oblongata, vagus nerve REZ were divided into four types: Contacting type (n=14), compressing type (n=10), adhesion type (n=9) and transfixing type (n=3). In the 36 patients, 24 hypertension cases (66.7%) were cured, 10 (27.8%) were improved, and2 (5.5%) did not get better. Conclusions Left medulla oblongata MVD is effective in treating primary hypertension. To explore and settle carefully of the drag stimulation like a string from the vessel loops deviated from the medulla, vague nerve REZ will improve the effects of medullary MVD for primary hypertension. Key words: Micro vascular decompression; Medulla oblongata; Vagus nerve; Primary hypertension; Cranial nerve disease; Offending vessel