MICROVASCULAR DECOMPRESSION OF THE LEFT LATERAL MEDULLA-OBLONGATA FORSEVERE REFRACTORY NEUROGENIC HYPERTENSION

OBJECTIVE: To demonstrate that microvascular decompression of the left medulla oblongata is a safe and effective modality for treating eleva ted blood pressure in patients with severe medically refractory ''esse ntial'' hypertension (HTN). METHODS: Twelve patients with medically in tractable HTN with or without autonomic dysreflexia underwent microvas cular decompression of the left rostral ventrolateral medulla oblongat a. Causes such as pheochromocytoma, carcinoid syndrome, and renal dise ase were ruled out before surgery. Indications for surgery included sy stolic blood pressures greater than 180 mm Hg refractory to three or m ore medications, severe blood pressure lability, or medically resistan t HTN at systolic pressures greater than 160 mm Hg associated with aut onomic 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. RESULTS: Ten of 12 patients experie nced reductions in systolic blood pressure greater than 20 mm Hg, Of t hese 10 patients, pressure reductions were temporary (6 mo) in two. Se ven of eight patients experienced improvement in blood pressure labili ty and/or autonomic dysreflexia, with five patients showing sustained improvements. CONCLUSION: Microvascular decompression of the left rost ral ventrolateral medulla oblongata may be an effective treatment moda lity for patients suffering from severe HTN and/or autonomic dysreflex ia refractory to medical management.