Frank H, Schobel H P, Heusser K, Geiger H, Fahlbusch R, Naraghi R
Medical Department IV/Nephrology, Clinic of Neurosurgery, University Erlangen, and Medical Department IV/Nephrology, University Frankfurt/Main, Germany.
Stroke. 2001 Dec 1;32(12):2950-5. doi: 10.1161/hs1201.099799.
In 1998, 8 patients with severe, intractable arterial hypertension and MR tomography-demonstrated neurovascular contact of a looping artery at the root entry zone of cranial nerves IX and X, causing neurovascular compression, underwent neurosurgical decompression. The short-term results showed a normalization of blood pressure with a markedly reduced antihypertensive drug regimen in 7 patients. To determine the longer-term outcome concerning blood pressure and secondary organ damage after neurovascular decompression, we studied these 8 operated patients prospectively for a mean follow-up of 3.5 years after surgical intervention.
Eight hypertensive patients who had undergone microsurgical decompression were monitored every 6 months after surgery to assess blood pressure (by 24-hour ambulatory pressure readings) and the need for antihypertensive medication. To evaluate secondary organ damage, echocardiographic assessment of left ventricular hypertrophy, fundoscopic assessment of hypertensive lesions, and analysis of renal function and proteinuria were done.
Three of the 8 operated patients remained normotensive in the long-term period with decreased antihypertensive medication. Two patients required gradual increases of antihypertensive medication after the first postoperative year, after which arterial blood pressure levels were 10% to 15% lower than preoperative levels. Three patients suffered serious cardiovascular and renal complications, with the incidence of lethal intracerebral hemorrhage in 1 patient and end-stage renal disease in 2 patients, of whom 1 experienced sudden cardiac death.
The long-term results verify that microsurgical decompression is a successful alternative therapy in a certain subgroup of patients with arterial hypertension due to neurovascular compression. However, the relevance of the looping artery in the other cases, who did not improve, is not clear. Prospective studies to elucidate the pathophysiological role of neurovascular abnormalities and arterial hypertension are needed.
1998年，8例患有严重顽固性动脉高血压且经磁共振断层扫描显示在第IX和第X对脑神经根部入口区有一条袢状动脉存在神经血管接触，导致神经血管受压的患者接受了神经外科减压手术。短期结果显示，7例患者血压恢复正常，降压药物治疗方案明显减少。为了确定神经血管减压术后血压及继发性器官损害的长期预后，我们对这8例接受手术的患者进行了前瞻性研究，术后平均随访3.5年。
8例接受显微手术减压的高血压患者术后每6个月接受监测，以评估血压（通过24小时动态血压读数）及降压药物需求。为评估继发性器官损害，进行了超声心动图评估左心室肥厚、眼底镜评估高血压病变以及肾功能和蛋白尿分析。
8例接受手术的患者中，3例长期血压正常，降压药物用量减少。2例患者在术后第1年之后需要逐渐增加降压药物用量，此后动脉血压水平比术前水平低10%至15%。3例患者出现严重的心血管和肾脏并发症，其中1例发生致命性脑出血，2例发生终末期肾病，其中1例经历心源性猝死。
长期结果证实，显微手术减压对于因神经血管受压导致动脉高血压的特定亚组患者是一种成功的替代治疗方法。然而，在其他未改善的病例中，袢状动脉的相关性尚不清楚。需要进行前瞻性研究以阐明神经血管异常与动脉高血压的病理生理作用。
