Arterial Hypertension After Macrovascular Decompression of Vertebrobasilar Dolichoectasia: Rethinking the Cause-Effect Relationship

Objective: This study evaluates the short-term and long-term efficacy, safety, and blood pressure (BP) outcomes in patients with hyperactive dysfunction syndromes (HDSs) caused by neurovascular conflict (NVC) from vertebrobasilar dolichoectasia (VBDE) treated with macrovascular decompression (MaVD), with a focus on BP changes postsurgery. Methods: We retrospectively analyzed 38 patients with HDS due to VBDE who underwent MaVD at Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan. Patients were grouped based on BP changes: worsened hypertension (HT), de novo HT, stable HT, and no HT. Demographic, clinical, surgical, and BP data were recorded and analyzed. Results: The majority of patients (65.8%) had hemifacial spasm, and 50% were hypertensive preoperatively. Postoperatively, 65.8% developed HT, with 52% showing worsened preoperative HT and 24% developing new HT. MaVD resolved symptoms in 86.8% of patients, with partial resolution in 13.1%. Left-sided NVC was more common, and preoperative HT was significantly associated with postoperative BP elevation. Complications included facial nerve deficits (13.1%) and hearing impairment (21%). Conclusions: MaVD proves highly effective in treating HDS from VBDE, with most patients achieving complete symptom resolution. However, a significant proportion experienced increased BP postoperatively, especially those with preexisting HT. These findings support Jannetta et al.'s theory of neurogenic HT and suggest that cardiovascular risk factors like age, male sex, and obesity may predispose patients to BP increases. Left-sided NVC and glossopharyngeal neuralgia may be protective. The transient nature of BP elevation indicates possible long-term compensation. Further studies are needed to clarify the mechanisms behind BP changes and improve management strategies postsurgery.