Late results of surgical therapy (sympathectomy and adrenalectomy)

Abstract

The fact that medical therapy often yielded unsatisfactory results in severe cases of hypertension, especially among younger patients suffering from malignant hypertension, led already some decades ago to attempts at surgical treatment in the form of neurosurgery. Brüning, in 1923, was the first to advocate resection of the splanchnic nerves. In America, Adson (1925) performed lumbar sympathectomy on hypertensive patients; later, together with Craig, he developed a method consisting of bilateral subdiaphragmatic resection of the splanchnic nerves and of the superior lumbar sympathetic chain (1935). In France, Leriche and Fontaine supplemented this procedure by unilateral adrenalectomy — in some cases together with renal decapsulation.