Effect of Anterior Chordotomy on Essential Hypertension

Abstract

Within the past 10 years there have been many reports concerning the surgical treatment of essential hypertension. 1 , 2 The methods used both in experimental animals and in man may be classified into 4 different groups : 3 (1) Interrupting sympathetic outflow by cutting anterior nerve roots from T₆ to L₂, 4 (2) dividing the splanchnic and the sympathetic chain above the diaphragm, 5 (3) dividing the splanchnic nerves and the lumbar sympathetic chain below the diaphragm, 6 and (4) removing the coeliac ganglion. 7

These various methods, however, have proved to be only partially successful, and this has stimulated us to attempt a new approach to the surgical treatment of essential hypertension. Gold-blatt's 8 ingenious experiments on dogs have shown that total sympa-thectomy of the thorax and abdomen, and even pithing, have had no effects on the type of experimental hypertension he produced. Based on the consideration that various forms of sympathectomy may reduce the blood pressure of patients with essential hypertension, but that these results were often disappointing, it was at first the intention of one of us (O.H.) to effect a more complete sympathectomy by partially sectioning the autonomic tracts in the cord. We observed, also, that when routine anterior chordotomy was performed for reasons other than hypertension, the operation was usually followed by a prolonged lowering of the blood pressure. Later it was found that, as far as the arterial pressure was concerned, a maximum result could be attained by beginning the section one to two mm anterior to the dentate ligament and carrying it to the anterior median fissure, thus interrupting the anterior and anterolateral columns of the cord.