Essentielle Hypertonie bei einem 16-jährigen Mädchen, das durch mikrovaskuläre Dekompression behandelt wurde

Hypertension in children, while less prevalent than in adults, is a clinically significant and increasingly acknowledged health issue. Characterised by elevated blood pressure levels, paediatric hypertension can have immediate and long-term consequences on a child's health, leading to organ damage, particularly to the heart, kidneys, and blood vessels, despite it being often asymptomatic. The etiology of hypertension in children is multifactorial and can involve genetic predisposition, obesity, sedentary behaviour, and specific medical disorders. Identifying and managing the condition early on is crucial in minimizing consequent health complications. In the late 1970s it was postulated neurovascular compression (NVC) of the ventrolateral medulla might play a role in the development of essential hypertension. Subsequently, limited research, encompassing both clinical and experimental studies, has delved into this potential cause and its corresponding treatment. Despite compelling anatomical/physiological evidence supporting the idea that compression of the root entry/exit zone (REZ) of the ninth and tenth cranial nerves (CN IX–X) and the adjacent ventrolateral medulla, predominantly on the left side, may be implicated in systemic arterial hypertension.

Various studies have employed MRI to identify compressive vessels associated with hypertension, revealing a heightened prevalence of vascular contact or compression at the ventrolateral medulla in hypertensive individuals compared to those with normal blood pressure. The surgical procedure involved micro-vascular decompression (MVD) at the ventrolateral medulla and CN IX–X REZ as a therapeutic intervention for the condition. Vascular nerve contacts on CN X and IX were identified and carefully dissected, with the nerves padded using a teflon sponge.

Following microvascular decompression of the left glossopharyngeal and vagus nerves, blood pressure values significantly decreased to normalized levels. Antihypertensive therapy was discontinued, and subsequent blood pressure measurements remained within the normotensive range.

Neurovascular compression may contribute to treatment-resistant hypertension, and microvascular decompression surgery appears to be an effective option for achieving blood pressure control. However, further research is needed to better understand the role of neurovascular abnormalities in hypertension and to optimize treatment strategies for this patient population.