RESEARCH ARTICLE


Neurovascular Compression in Arterial Hypertension: Correlation of Clinical Data to 3D-Visualizations of MRI-Findings



Panagiota Manava1, 5, *, Peter Hastreiter1, Roland E. Schmieder2, Susanne Jung2, Rudolf Fahlbusch1, 4, Arnd Dörfler3, Michael M. Lell5, 7, Michael Buchfelder1, Ramin Naraghi1, 6
1 Department of Neurosurgery, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Erlangen
2 Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Erlangen, Germany
3 Division of Neuroradiology, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Erlangen, Germany
4 International Neuroscience Institute, Hannover, Germany
5 Institute of Radiology and Nuclear Medicine, Paracelsus Private Medical University, Salzburg, Austria
6 Department of Neurosurgery, German Armed Forces Hospital Koblenz, Koblenz, Germany
7 Department of Radiology, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany


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Creative Commons License
© 2021 Manava et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Institute of Radiology and Nuclear Medicine, Paracelsus Private Medical University, Nuremberg Campus, Prof. Ernst-Nathan Str. 1, 90419 Nuernberg, Germany; Tel: +49 911-398-114930; E-mail: Panagiota.Manava@klinikum-nuernberg.de


Abstract

Aims:

In this study, we attempted to identify clinical parameters predicting the absence or presence of Neurovascular Compression (NVC) at the Ventrolateral Medulla (VLM) in arterial hypertension (HTN) in MRI findings.

Background:

Cardiovascular and pulmonary afferences are transmitted through the left vagus and glossopharyngeal nerve to the brain stem and vasoactive centers. Evidence supports the association between HTN and NVC at the left VLM. Several independent studies indicate a reduction of HTN after Microvascular Decompression (MVD) of the left. Several independent studies indicate a reduction of HTN after Microvascular Decompression (MVD) of the left VLM. Image processing of MRI provides comprehensible detection of NVC. HTN affects hemodynamic parameters and organs.

Objective:

This study analyzes and correlates clinical data and MRI findings in patients with and without NVC at the VLM in treatment resistant HTN to obtain possible selection criteria for neurogenic hypertension.

Methods:

In 44 patients with treatment resistant HTN, we compared MRI findings of neurovascular imaging to demographic, clinical and lifestyle data, office and 24-hour ambulatory Blood Pressure (BP), and cardiovascular imaging and parameters.

Results:

Twenty-nine (66%) patients had evidence of NVC at the VLM in MRI. Sixteen patients (36%) had unilateral NVC on the left side, 7 (16%) unilateral right and 6 (14%) bilateral NVC. Fifteen (34%) had no evidence of NVC at the VLM. Patients with left sided NVC were significantly younger, than those without NVC (p=0.034). They showed a statistically significant variance in daytime (p=0.020) and nighttime diastolic BP (p<0.001) as the mean arterial pressure (p=0.020). Other measured parameters did not show significant differences between the two groups.

Conclusion:

We suggest to examine young adults with treatment resistant HTN for the presence of NVC at VLM, before signs of permanent organ damage appear. Clinical and hemodynamic parameters did not emerge as selection criteria to predict NVC. MVD as a surgical treatment of NVC in HTN is not routine yet as a surgical treatment of NVC in HTN is not routine yet. Detection of NVC by imaging and image processing remains the only criteria to suggest MVD, which should be indicated on an individual decision.

Keywords: Neurovascular compression, Hypertension, Ventrolateral medulla, Image fusion, Neuroimaging, MRI.