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Intraoperative Hypertensive Urgency and Hemodynamic Instability during Microvascular Decompression for Trigeminal Neuralgia


 Objective To evaluate the factors predisposing to rare events of intraoperative hypertensive urgency during microvascular decompression (MVD) for trigeminal neuralgia (TGN) and outcome of MVD on long-term blood pressure (BP) control.
 Patients and Methods Total 54 consecutive TGN patients who failed medical management in two institutions from January 2012 to January 2017 were included in the study. MVD of TGN was done through retromastoid suboccipital craniotomy. Intraoperative “hypertensive urgency” and hemodynamic instability were observed in two patients with BP shooting up to > 180/120 mm Hg, which was controlled. Postoperative 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 antihypertensive 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 urgency. Postoperative long-term BP control in hypertensive patients is not feasible after MVD in this study, which needs further detailed analysis.