Levy E I, Clyde B, McLaughlin M R, Jannetta P J
Department of Neurological Surgery, The University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
Neurosurgery. 1998 Jul;43(1):1-6; discussion 6-9. doi: 10.1097/00006123-199807000-00001.
To demonstrate that microvascular decompression of the left medulla oblongata is a safe and effective modality for treating elevated blood pressure in patients with severe medically refractory "essential" hypertension (HTN).
Twelve patients with medically intractable HTN with or without autonomic dysreflexia underwent microvascular decompression of the left rostral ventrolateral medulla oblongata. Causes such as pheochromocytoma, carcinoid syndrome, and renal disease were ruled out before surgery. Indications for surgery included systolic blood pressures greater than 180 mm Hg refractory to three or more medications, severe blood pressure lability, or medically resistant HTN at systolic pressures greater than 160 mm Hg associated with autonomic dysreflexia and/or magnetic resonance images demonstrating left medullary compression. The median age and follow-up duration were 51 years and 4.1 years, respectively.
Ten of 12 patients experienced reductions in systolic blood pressure greater than 20 mm Hg. Of these 10 patients, pressure reductions were temporary (6 mo) in two. Seven of eight patients experienced improvement in blood pressure lability and/or autonomic dysreflexia, with five patients showing sustained improvements.
Microvascular decompression of the left rostral ventrolateral medulla oblongata may be an effective treatment modality for patients suffering from severe HTN and/or autonomic dysreflexia refractory to medical management.
证明左侧延髓微血管减压术是治疗药物治疗效果不佳的重度“原发性”高血压（HTN）患者血压升高的一种安全有效的方法。
12例药物治疗难治性HTN患者，伴有或不伴有自主神经反射异常，接受了左侧延髓头端腹外侧微血管减压术。术前排除了嗜铬细胞瘤、类癌综合征和肾病等病因。手术指征包括收缩压大于180mmHg，对三种或更多药物治疗无效，严重的血压波动，或收缩压大于160mmHg的药物抵抗性HTN伴有自主神经反射异常和/或磁共振成像显示左侧延髓受压。中位年龄和随访时间分别为51岁和4.1年。
12例患者中有10例收缩压降低超过20mmHg。在这10例患者中，有2例血压降低是暂时的（6个月）。8例患者中有7例血压波动和/或自主神经反射异常得到改善，其中5例患者持续改善。
左侧延髓头端腹外侧微血管减压术可能是治疗重度HTN和/或药物治疗难治性自主神经反射异常患者的一种有效治疗方法。
