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Microvascular decompression in the treatment of hypertension: review and update
E I Levy1, A M Scarrow, P J Jannetta
1Department of Neurosurgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213-2582, USA.
Insights
Surgical decompression of the left rostral ventrolateral medulla may offer relief for neurogenic hypertension. Further randomized studies are needed to confirm the efficacy of microvascular decompression for essential hypertension.
Area of Science:
- Neurology
- Neurosurgery
- Cardiovascular Medicine
Background:
- Neurogenic hypertension linked to vascular compression of the left rostral ventrolateral medulla.
- Clinical reports suggest brainstem decompression as a potential therapy for essential hypertension.
Purpose of the Study:
- To elucidate the mechanism of hypertension relief through left rostral ventrolateral medulla decompression.
- To consolidate evidence from basic science, animal models, human studies, and clinical trials.
Main Methods:
- Review of basic science principles.
- Analysis of animal models investigating neurogenic hypertension.
- Examination of human studies and clinical trials on surgical decompression.
Main Results:
- Multi-disciplinary evidence supports microvascular decompression for a subset of hypertensive patients.
- Significant hypertension relief observed in patients undergoing this procedure.
Conclusions:
- A sub-population of hypertensive patients may benefit from microvascular decompression.
- A prospective, randomized, multi-institutional study is required to establish definitive efficacy.
Background:
Neurogenic hypertension in association with vascular compression of the left rostral ventrolateral medulla has been documented. A recent group of these clinical reports has raised great interest in decompression of this area of the brainstem as a definitive therapy for essential hypertension.
Methods:
To further clarify the mechanism by which decompression of the left rostral ventrolateral medulla relieves neurogenic hypertension, we describe in detail the basic science, animal models, human studies, and most recent clinical trials regarding surgical decompression of this area.
Conclusion:
Multi-disciplinary evidence supports the hypothesis that a sub-population of hypertensive patients achieve significant relief of their hypertension after microvascular decompression. A multi-institutional, prospective, randomized study is necessary to determine the efficacy of microvascular decompression for neurogenic hypertension.