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Neurovascular compression and decompression of the intracranial vagus for blood pressure
Authors:Kehua Sun  Yicheng Lu  Qifu Tan  Hua Fu and Lijun Hou
Institution:Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA, Shanghai Neurosurgery Institute;Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA;Department of Neurosurgery, General Hospital of Nanjing Military Area Command of Chinese PLA;Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA, Shanghai Neurosurgery Institute;Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA, Shanghai Neurosurgery Institute
Abstract:BackgroundPrevious researches demonstrated that neurovascular decompression could cure hypertension; however, whether it could effectively control refractory hypertension after hypertensive cerebral hemorrhage should be further studied.ObjectiveTo observe the effect of neruovascular compression on intracranial vagus for blood pressure of dogs and investigate the effect of neurovascular decompression on blood pressure of patients with hypertensive cerebral hemorrhage.DesignRandomized controlled animal study, clinical effects and retrospective analysis.SettingDepartment of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA.MaterialsThe experiment was carried out in the Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA from May to October 2006. A total of 15 healthy adult dogs of both genders were randomly divided into experimental group (n =10) and control group (n =5). Clinical observation: A total of 41 patients with hypertensive cerebral hemorrhage were selected from the Department of Neurosurgery, General Hospital of Nanjing Military Area Command of Chinese PLA and the Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA from October 1999 to October 2006. Among them, one patient had brain stem hemorrhage. There were 27 males and 14 females aged from 41 to 66 years. Inclusion criteria: All patients were diagnosed with CT examination once or several times. Volume of hematoma ranged from 50 to 120 mL and had obviously operative indication. All patients provided consents. In addition, another 281 patients with hypertensive cerebral hemorrhage who received traditionally internal and surgical therapies in our departments of neurosurgery, neurology and emergency room were selected in the control group.Methods
></figure> Animal experiments: 20 cm autochthonous great saphenous vein was taken from dogs in the experimental group and coincided with tip of facial artery to form arterial loop so as to oppress left vagus and lateral bulb abdomen. In addition, 20 cm autochthonous great saphenous vein was taken from dogs in the control group and coincided with tip of facial artery to establish arterial loop so as to oppress left cerebellum to observe changes of blood pressure before and at 1, 2, 3 and 4 weeks after operation. <figure class=></figure> Clinical observation: Among 41 patients with hypertensive cerebral hemorrhage including one with brain stem hemorrhage, they received microvascular decompression of vagus immediately after getting rid of intracerebral hematoma and stopping bleeding to observe its effect of depressurization. All patients and their relatives provided consents. <figure class=></figure> A total of 281 patients with hypertensive cerebral hemorrhage who discharged after the treatment of traditionally internal and surgical therapies were studied retrospectively to observe changes of blood pressure after routine treatment and compare the results with neurovascular decompression.<b>Main outcome measures</b><figure class=></figure> Changes of blood pressure of experimental dogs; <figure class=></figure> effect of vascular decompression of vagus for blood pressure of patients with hypertensive cerebral hemorrhage after clearing intracerebral hematoma; <figure class=></figure> different effects of neurovascular decompression and routinely internal and surgical therapies on hypertension.<b>Results</b><figure class=></figure> Results of animal experiments: Nine dogs in the experimental group survived. At 1, 2, 3 and 4 weeks after operation, blood pressure of dogs in the experimental group was (139.77±4.06), (149.11±4.90), (148.10±4.16), (147.76±4.15) mm Hg (1 mm Hg=0.133 kPa), which was higher than that of dogs in the control group (117.20±2.74), (116.65±3.74), (116.26±1.8), (115.81±3.76) mm Hg, <em>P</em> < 0.01]. <figure class=></figure> Results of clinical observation: Among 41 patients, 8 (20%) cases died during the operation. In addition, among other 33 (80%) survival patients, 11 (33%) cases had normal blood pressure; blood pressure of 14 (43%) cases was improved or closed to normal value; blood pressure of 8 (24%) cases was not changed obviously as compared with that before operation. <figure class=></figure> The results demonstrated that, by using traditionally internal and surgical therapies, among 281 patients with hypertensive cerebral hemorrhage, blood pressure of about 15% cases was recovered or closed to normal value. Those mentioned above did not have history of hypertension before hemorrhage. However, patients who had history of hypertension before hemorrhage received the traditionally internal or surgical therapies, and the blood pressure was not improved to the normal value after the treatment.<b>Conclusion</b><figure class=></figure> Neurovascular compression in left intracranial vagus can cause obvious increase of blood pressure of dogs, and the increasing volume was 30 mm Hg. <figure class=></figure> Vascular decompression of vagus has a great effect on refractory hypertension, and the improvement of blood pressure is superior to traditionally internal and surgical therapies in clinic.</td> </tr> <tr> <td align=
Keywords:decompression  vagus nerve  blood pressure
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