Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
Priority Organization for Innovation and Excellence, Kumamoto University, 2-39-1 Kurokami, Chuo-ku, Kumamoto 860-0862, Japan.
Clin Neurophysiol. 2021 Jun;132(6):1264-1273. doi: 10.1016/j.clinph.2021.03.006. Epub 2021 Mar 24.
The purpose of this study is to investigate changes in autonomic activities and systemic circulation generated by surgical manipulation or electrical stimulation to the human brain stem.
We constructed a system that simultaneously recorded microsurgical field videos and heart rate variability (HRV) that represent autonomic activities. In 20 brain stem surgeries recorded, HRV features and sites of surgical manipulation were analyzed in 19 hypertensive epochs, defined as the periods with transient increases in the blood pressure. We analyzed the period during electrical stimulation to the ponto-medullary junction, performed for the purpose of monitoring a cranial nerve function.
In the hypertensive epoch, HRV analysis showed that sympathetic activity predominated over the parasympathetic activity. The hypertensive epoch was more associated with surgical manipulation of the area in the caudal pons or the rostral medulla oblongata compared to controls. During the period of electrical stimulation, there were significant increases in blood pressures and heart rates, accompanied by sympathetic overdrive.
Our results provide physiological evidence that there is an important autonomic center located adjacent to the ponto-medullary junction.
A large study would reveal a candidate target of neuromodulation for disorders with autonomic imbalances such as drug-resistant hypertension.
本研究旨在探讨手术操作或电刺激对人脑干引起的自主活动和全身循环的变化。
我们构建了一个系统，该系统可同时记录代表自主活动的显微手术现场视频和心率变异性 (HRV)。在记录的 20 例脑干手术中，分析了 19 个高血压期的 HRV 特征和手术操作部位，高血压期定义为血压短暂升高的时期。我们分析了对桥延髓交界处进行电刺激的时期，该操作是为了监测颅神经功能而进行的。
在高血压期，HRV 分析显示交感活动占优势。与对照相比，高血压期与桥脑尾部或延髓前部的手术操作区域更相关。在电刺激期间，血压和心率显著升高，伴有交感神经亢进。
我们的结果提供了生理学证据，表明在桥延髓交界处附近存在一个重要的自主中枢。
一项大型研究将揭示候选的神经调节靶点，用于治疗自主失衡相关疾病，如耐药性高血压。
