PDF(Pubmed)
Abstract：
UNASSIGNED: Neurogenic hypertension (HTN) is a type of HTN characterized by increased activity of the sympathetic nervous system. Vascular compression is one of the pathogenic mechanisms of neurogenic HTN. Despite Jannetta\'s solid anatomical and physiological arguments in favor of neurogenic HTN in the 1970\'s, the treatment for essential HTN by microvascular decompression (MVD) still lacks established selection criteria. Therefore, the subjects selected for our center were limited to patients with primary trigeminal neuralgia (TN) and primary hemifacial spasm (HFS) of the vertebral/basilar artery (VA/BA) responsible vessel type coexisting with neurogenic HTN who underwent MVD of the brainstem to further explore possible indications for MVD in the treatment of neurogenic HTN.
UNASSIGNED: A retrospective analysis of 63 patients who were diagnosed with neurogenic HTN had symptoms of HFS and TN cranial nerve disease. Patients were treated at our neurosurgery department from January 2018 to January 2023. A preoperative magnetic resonance examination of the patients revealed the presence of abnormally located vascular compression in the rostral ventrolateral medulla (RVLM) and the root entry zone (REZ) of the IX and X cranial nerves (CN IX- X).
UNASSIGNED: There was no significant difference between the two groups in terms of gender, age, course of HFS, course of TN, course of HTN, degree of HTN, or preoperative blood pressure. Based on the postoperative blood pressure levels, nine out of 63 patients were cured (14.28%), eight cases (12.70%) showed a marked effect, 16 cases (25.40%) were effective, and 30 cases were invalid (47.62%). The overall efficacy was 52.38%. However, 39 cases of combined cranial nerve disease were on the left side of the efficacy rate (66.67%) and 24 cases of combined cranial nerve disease were on the right side of the efficacy rate (29.16%).
UNASSIGNED: Over the last few decades, many scholars have made pioneering progress in the clinical retrospective study of MVD for neurogenic hypertension, and our study confirms the efficacy of MVD in treating vertebral/basilar artery-type neurogenic hypertension by relieving the vascular pressure of RVLM. In the future, with the development and deepening of pathological mechanisms and clinical observational studies, MVD may become an important treatment for neurogenic hypertension by strictly grasping the surgical indications.
UNASSIGNED: MVD is an effective treatment for neurogenic HTN. Indications may include the following: left-sided TN or HFS combined with neurogenic HTN; VA/BA compression in the left RVLM and REZ areas on MRI; and blood pressure in these patients cannot be effectively controlled by drugs.
UNASSIGNED: A retrospective analysis of 63 patients who were diagnosed with neurogenic HTN had symptoms of HFS and TN cranial nerve disease. Patients were treated at our neurosurgery department from January 2018 to January 2023. A preoperative magnetic resonance examination of the patients revealed the presence of abnormally located vascular compression in the rostral ventrolateral medulla (RVLM) and the root entry zone (REZ) of the IX and X cranial nerves (CN IX- X).
UNASSIGNED: There was no significant difference between the two groups in terms of gender, age, course of HFS, course of TN, course of HTN, degree of HTN, or preoperative blood pressure. Based on the postoperative blood pressure levels, nine out of 63 patients were cured (14.28%), eight cases (12.70%) showed a marked effect, 16 cases (25.40%) were effective, and 30 cases were invalid (47.62%). The overall efficacy was 52.38%. However, 39 cases of combined cranial nerve disease were on the left side of the efficacy rate (66.67%) and 24 cases of combined cranial nerve disease were on the right side of the efficacy rate (29.16%).
UNASSIGNED: Over the last few decades, many scholars have made pioneering progress in the clinical retrospective study of MVD for neurogenic hypertension, and our study confirms the efficacy of MVD in treating vertebral/basilar artery-type neurogenic hypertension by relieving the vascular pressure of RVLM. In the future, with the development and deepening of pathological mechanisms and clinical observational studies, MVD may become an important treatment for neurogenic hypertension by strictly grasping the surgical indications.
UNASSIGNED: MVD is an effective treatment for neurogenic HTN. Indications may include the following: left-sided TN or HFS combined with neurogenic HTN; VA/BA compression in the left RVLM and REZ areas on MRI; and blood pressure in these patients cannot be effectively controlled by drugs.
摘要：
■神经源性高血压（HTN）是一种HTN，其特征在于交感神经系统活动增加。血管压缩是神经源性HTN的致病机制之一。尽管Jannetta在1970年代有坚实的解剖学和生理学论据支持神经源性HTN，微血管减压术(MVD)治疗原发性HTN仍缺乏确定的选择标准.因此,我们中心选择的受试者仅限于原发性三叉神经痛(TN)和原发性椎/基底动脉(VA/BA)负责血管型与神经源性HTN并存的面肌痉挛(HFS)患者,这些患者接受了脑干MVD治疗,以进一步探讨MVD治疗神经源性HTN的可能指征.
■回顾性分析63例诊断为神经源性HTN的患者有HFS和TN脑神经疾病的症状。患者于2018年1月至2023年1月在我们的神经外科接受治疗。患者的术前磁共振检查显示，在IX和X颅神经（CNIX-X）的延髓腹外侧（RVLM）和根部进入区（REZ）中存在异常定位的血管压迫。
■两组在性别方面没有显着差异，年龄,HFS课程，TN课程，HTN课程，HTN的程度，或术前血压。根据术后血压水平,63例患者中有9例治愈(14.28%)，8例(12.70%)显效，16例（25.40%）有效，无效30例(47.62%)。总有效率为52.38%。然而,39例合并脑神经疾病均在左侧显效率(66.67%),24例合并脑神经疾病均在右侧显效率(29.16%)。
■在过去的几十年里，许多学者在神经源性高血压MVD的临床回顾性研究方面取得了开创性的进展，我们的研究证实了MVD通过缓解RVLM的血管压力治疗椎/基底动脉型神经源性高血压的疗效。在未来,随着病理机制和临床观察研究的发展和深入，严格掌握手术适应证,MVD可能成为治疗神经源性高血压的重要手段。
■MVD是神经源性HTN的有效治疗方法。适应症可能包括：左侧TN或HFS合并神经源性HTN；MRI上左侧RVLM和REZ区域的VA/BA受压；这些患者的血压无法通过药物有效控制。
■回顾性分析63例诊断为神经源性HTN的患者有HFS和TN脑神经疾病的症状。患者于2018年1月至2023年1月在我们的神经外科接受治疗。患者的术前磁共振检查显示，在IX和X颅神经（CNIX-X）的延髓腹外侧（RVLM）和根部进入区（REZ）中存在异常定位的血管压迫。
■两组在性别方面没有显着差异，年龄,HFS课程，TN课程，HTN课程，HTN的程度，或术前血压。根据术后血压水平,63例患者中有9例治愈(14.28%)，8例(12.70%)显效，16例（25.40%）有效，无效30例(47.62%)。总有效率为52.38%。然而,39例合并脑神经疾病均在左侧显效率(66.67%),24例合并脑神经疾病均在右侧显效率(29.16%)。
■在过去的几十年里，许多学者在神经源性高血压MVD的临床回顾性研究方面取得了开创性的进展，我们的研究证实了MVD通过缓解RVLM的血管压力治疗椎/基底动脉型神经源性高血压的疗效。在未来,随着病理机制和临床观察研究的发展和深入，严格掌握手术适应证,MVD可能成为治疗神经源性高血压的重要手段。
■MVD是神经源性HTN的有效治疗方法。适应症可能包括：左侧TN或HFS合并神经源性HTN；MRI上左侧RVLM和REZ区域的VA/BA受压；这些患者的血压无法通过药物有效控制。
