scholarly journals Hypertension of neurogenic origin: effect of microvascular decompression of the CN IX-X root entry/exit zone and ventrolateral medulla on blood pressure in a prospective series of 48 patients with hemifacial spasm associated with essential hypertension

2015 ◽  
Vol 123 (6) ◽  
pp. 1405-1413 ◽  
Author(s):  
Marc Sindou ◽  
Mohamed Mahmoudi ◽  
Andrei Brînzeu
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
High Resolution ◽  
Medical Treatment ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Ventrolateral Medulla ◽  
Vascular Compression ◽  
Who Grade

OBJECT In spite of solid anatomical and physiological arguments and the promising results of Jannetta in the 1970s, treating essential hypertension by microvascular decompression (MVD) of the brainstem has not gained acceptance as a mainstream technique. The main reason has been a lack of established selection criteria. Because of this, the authors' attempts have been limited to patients referred for MVD for hemifacial spasm (HFS) who also had hypertension likely to be related to neurovascular compression (NVC). METHODS Of 201 patients referred for HFS, 48 (23.8%) had associated hypertension. All had high-resolution MR images that demonstrated NVC. All underwent MVD of the root exit/entry zone (REZ) of the ninth and tenth cranial nerves (CN IX-X) and adjacent ventrolateral medulla in addition to the CN VII REZ. Effects on hypertension, graded using the WHO classification, were studied up to the latest follow-up, which was 2–16 years from the time of surgery, 7 years on average. Also, effects of MVD on blood pressure (BP) according to the side of vascular compression were evaluated. RESULTS Preoperatively, hypertension was severe in all but 1 of the patients; in spite of medical treatment, 47 patients still had WHO Grade 1 or 2 hypertension, and 18 still had unstable BP. After MVD, at latest follow-up, BP had returned to normal (i.e., systolic pressure < 140 mm Hg) in 28 patients; 14 of these patients (29.10% of the whole series) were able to maintain normal BP without any antihypertensive treatment; the other 14 still required some medication to maintain their BP below 140 mm Hg (p < 0.0001). Also, at latest follow-up, BP remained unstable in only 8 of the 18 patients with instability prior to MVD (p < 0.02). Analysis according to side of compression showed that of the 30 patients with left-sided compression, 17 had their BP normalized (without medication in 11 cases), and of the 18 patients with right-sided compression, 11 had their BP normalized (without medication in 3 cases). The difference between sides was not significant. CONCLUSIONS These results argue for considering MVD for the treatment of hypertension likely to be due to NVC at the CN IX-X REZ and adjacent ventrolateral medulla. Criteria for selecting patients with hypertension alone still need to be established and could include the following indications: apparently essential hypertension, likely to be neurogenic, in patients in whom high-resolution MRI shows clear-cut images of NVC at the CN IX-X REZ and adjacent ventrolateral medulla and in whom BP cannot be controlled by medical treatment.

Microvascular decompression for hemifacial spasm

1991 ◽  
Vol 75 (3) ◽  
pp. 388-392 ◽  
Author(s):  
Shinji Nagahiro ◽  
Akira Takada ◽  
Yasuhiko Matsukado ◽  
Yukitaka Ushio
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Anterior Inferior Cerebellar Artery ◽  
Vascular Compression ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Cerebellar Artery

✓ To determine the causative factors of unsuccessful microvascular decompression for hemifacial spasm, the follow-up results in 53 patients were assessed retrospectively. The mean follow-up period was 36 months. There were 32 patients who had compression of the seventh cranial nerve ventrocaudally by an anterior inferior cerebellar artery (AICA) or a posterior inferior cerebellar artery. Of these 32 patients, 30 (94%) had excellent postoperative results. Of 14 patients with more severe compression by the vertebral artery, nine (64%) had excellent results, three (21%) had good results, and two (14%) had poor results; in this group, three patients with excellent results experienced transient spasm recurrence. There were seven patients in whom the meatal branch of the AICA coursed between the seventh and eighth cranial nerves and compressed the dorsal aspect of the seventh nerve; this was usually associated with another artery compressing the ventral aspect of the nerve (“sandwich-type” compression). Of these seven patients, five (71%) had poor results including operative failure in one and recurrence of spasm in four. The authors conclude that the clinical outcome was closely related to the patterns of vascular compression.

Microvascular Decompression by the Retrosigmoid Approach for Idiopathic Hemifacial Spasm: Experience with 300 Cases

1995 ◽  
Vol 104 (8) ◽  
pp. 610-612 ◽  
Author(s):  
Kai-wen Zhang ◽  
Zi-ting Shun
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Retrosigmoid Approach ◽  
Vascular Compression ◽  
Cure Rate ◽  
Facial Weakness ◽  
Postoperative Meningitis

Three hundred patients with idiopathic hemifacial spasm who underwent microvascular decompression through the retrosigmoid approach are reported. Vascular compression was found in every patient on operation. The results of 1 to 6 years of follow-up show that 276 patients are free of the symptom, 4 patients have markedly diminished spasms and a decreased episode rate, 10 patients have no significant relief from the operation, and 9 have had recurrences of the symptom since the operation. The cure rate in this group is 92%. Complications were sensorineural hearing loss in 13 patients (7 temporary cases, 6 permanent), tinnitus in 7 (4 temporary cases, 3 permanent), temporary postoperative facial weakness in 16, and postoperative meningitis in 10 (9 cases were controlled with antibiotics and 1 patient died).

Microvascular decompression for hemifacial spasm: postoperative neurologic follow-up and evaluation of life quality

2007 ◽  
Vol 14 (3) ◽  
pp. 335-340 ◽  
Author(s):  
K. Heuser ◽  
E. Kerty ◽  
P. K. Eide ◽  
M. Cvancarova ◽  
E. Dietrichs
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Life Quality

scholarly journals A Blood Pressure Lowering Effect Only through Complex Korean Medical Treatment, without Antihypertensive Drugs, for Patients with Stress Induced Hypertension - A Case Report

2021 ◽  
Vol 42 (5) ◽  
pp. 808-819
Author(s):  
Ji-hyun Lee ◽  
Min-yeong Roh ◽  
Seok-yeong Yoon ◽  
Hyung-sun Jun ◽  
Yang-hee Han ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medical Treatment ◽  
Antihypertensive Drugs ◽  
Blood Pressure Lowering Effect ◽  
Hypertensive Patients ◽  
Pittsburg Sleep Quality Index ◽  
Induced Hypertension ◽  
Pressure Lowering ◽  
Pressure Symptom

Objectives: This study considered the effectiveness of integrative Korean medical treatment for stress-induced hypertensive patients without the use of conventional medication.Methods: A 62-year-old female with stress-induced hypertension (HTN) was hospitalized for 33 days. Her pattern identification was ascendant hyperactivity of liver yang (Ganyangsanghang)-type HTN. Herbal medicine and acupuncture were used for the treatment: Cheonggansoyo-san for 33 days and Chunwangbosim-dan for 15 days, together with acupuncture for 20 minutes twice a day. Blood pressure was checked daily during hospitalization with a digital sphygmomanometer in the brachial artery.Results: After 33 days of treatment, blood pressure decreased. The Handicap Inventory (DHI) scale and Pittsburg Sleep Quality Index (PSQI) scores both decreased. The patient also reported fewer complaints. A five-month follow-up after discharge, with no further treatment, confirmed stable blood pressure. Symptom improvements continued with no significant side effects.Conclusions: This study indicates that Korean medical treatment is effective for stress-induced hypertensive patients.

A New Application of Gelatin Sponge in the Treatment of Hemifacial Spasm by Microvascular Decompression: A Technical Note

2021 ◽  
Author(s):  
Bowen Chang ◽  
Yinda Tang ◽  
Xiangyu Wei ◽  
Shiting Li
Keyword(s):  
Hearing Loss ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Facial Palsy ◽  
Poor Response ◽  
Technical Note ◽  
Gelatin Sponge ◽  
Group Differences ◽  
Success Rates

Abstract Objectives Microvascular decompression (MVD) for facial nerve remains the highly efficient hemifacial spasm (HFS) treatment. Nonetheless, a variety of cases have poor response to MVD. Using Teflon plus gelatin sponge in MVD seems to be a good solution. No existing study has examined the efficacy of using Teflon combined with gelatin sponge during MVD for HFS. Therefore, this study aimed to compare the efficacy of Teflon combined with gelatin sponge in HFS patients relative to that of Teflon alone. Patients and Methods We retrospectively compared the follow-up results of patients treated with Teflon and gelatin sponge with those treated with Teflon alone previously. Six hundred and eighty-eight primary HFS patients undergoing surgery from January 2010 to January 2018 were retrospectively analyzed. Three hundred and forty-seven cases received simple Teflon, while 342 cases underwent Teflon combined with gelatin sponge. Results In the Teflon plus gelatin sponge group, the incidences of facial palsy and hearing loss at 1 day, 1 year, and 2 years following surgery was significantly lower than those in the simple Teflon group. Differences in the success rates between Teflon plus gelatin sponge and the simple Teflon group were not statistically significant at 1 day, 1 year, and 2 years after surgery. The recurrence rate in the Teflon plus gelatin sponge group was significantly lower at 2 years. Conclusion For HFS patients undergoing MVD, using Teflon plus gelatin sponge can remarkably reduce the incidence of recurrence, facial palsy, and hearing loss compared with those using Teflon alone.

Endoscopic-Assisted Microvascular Decompression

2018 ◽  
pp. 139-154
Author(s):  
M. Yashar S. Kalani ◽  
Michael R. Levitt ◽  
Celene B. Mulholland ◽  
Charles Teo ◽  
Peter Nakaji
Keyword(s):  
Trigeminal Neuralgia ◽  
Minimally Invasive ◽  
Effective Treatment ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Patient Population ◽  
Surgical Intervention ◽  
Cranial Nerves ◽  
Vascular Compression ◽  
Ephaptic Transmission

Diseases of ephaptic transmission are commonly caused by vascular compression of cranial nerves. The advent of microvascular decompression has allowed for surgical intervention for this patient population. This chapter highlights the technique of endoscopic-assisted microvascular decompression for trigeminal neuralgia and hemifacial spasm. Endoscopy and keyhole techniques have resulted in a minimally invasive and effective treatment of symptoms for patients with neuralgia.

scholarly journals Long-Term Use of Aldosterone-Receptor Antagonists in Uncontrolled Hypertension: A Retrospective Analysis

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Pieter M. Jansen ◽  
Koen Verdonk ◽  
Ben P. Imholz ◽  
A. H. Jan Danser ◽  
Anton H. van den Meiracker
Keyword(s):  
Blood Pressure ◽  
Multivariate Analysis ◽  
Essential Hypertension ◽  
Primary Aldosteronism ◽  
Treatment Duration ◽  
Uncontrolled Hypertension ◽  
Receptor Antagonists ◽  
Aldosterone Receptor

Background. The long-term efficacy of aldosterone-receptor antagonists (ARAs) as add-on treatment in uncontrolled hypertension has not yet been reported.Methods. Data from 123 patients (21 with primary aldosteronism, 102 with essential hypertension) with difficult-to-treat hypertension who received an ARA between May 2005 and September 2009 were analyzed retrospectively for their blood pressure (BP) and biochemical response at first followup after start with ARA and the last follow-up available.Results. Systolic BP decreased by22±20and diastolic BP by9.4±12 mmHg after a median treatment duration of 25 months. In patients that received treatment >5 years, SBP was33±20and DBP was 16 ± 13 mmHg lower than at baseline. Multivariate analysis revealed that baseline BP and follow-up duration were positively correlated with BP response.Conclusion. Add-on ARA treatment in difficult-to-treat hypertension results in a profound and sustained BP reduction.

Sign in / Sign up

Export Citation Format

Share Document