Publication

Abstract : Objective To evaluate the factors predisposing to rare events of intraoperative hypertensive urgency during microvascular decompression (MVD) for trigeminal neu- ralgia (TGN) and outcome of MVD on long-term blood pressure (BP) control. Patients and Methods Total 54 consecutive TGN patients who failed medical man- agement in two institutions from January 2012 to January 2017 were included in the study. MVD of TGN was done through retromastoid suboccipital craniotomy. Intraop- erative “hypertensive urgency” and hemodynamic instability were observed in two patients with BP shooting up to > 180/120 mm Hg, which was controlled. Postoper- ative period was uneventful and patients were discharged. Patients were reviewed in the OPD clinic at 1 and 6 months after discharge and their clinical status was evaluated. The collected data were analyzed retrospectively. Results Of the 54 patients, 32 (59.26%) were male and 22 (40.74%) were female. Twenty-five (46.30%) patients were hypertensive, out of whom 19 (76%) were in Joint National Committee (JNC) 7 stage 1 and 6 (24%) were in stage 2. Two (3.70%) patients had an intraoperative hypertensive crisis, and in both the patients, the offending vessel was an atheromatous ectatic vertebrobasilar artery. Postoperative long-term BP control or normalization was observed in one of the two patients with a single antihy- pertensive drug who was on three antihypertensive drugs preoperatively. Conclusion Intraoperative hypertensive urgency is a medical emergency that can be encountered in MVD surgery for TGN, and an ectatic atheromatous vertebrobasilar arterial compression on the nerve is notorious for predisposing to hypertensive urgen- cy. Postoperative long-term BP control in hypertensive patients is not feasible after MVD in this study, which needs further detailed analysis.