03:15am Friday 20 October 2017

MRI Study Suggests Brain Blood Vessel Abnormality May Be Factor in Parkinson’s Disease

Recognized worldwide as one of the preeminent authorities on diseases associated with vascular compression of cranial nerves, the study’s lead author, Peter Jannetta, MD, is credited with developing the modern surgical technique to treat such conditions.  Called microvascular decompression (MVD), the procedure involves repositioning compressive arteries in the brain and placing a protective pad between the artery and the structure it is compromising.
It was in course of treating a patient for the cranial nerve disease trigeminal neuralgia who also suffered from Parkinson’s Disease that Dr. Jannetta first observed the possible role of vascular compression in Parkinson’s. In addition to vascular compression of the left trigeminal nerve, the patient also had notable compression of an area of the brain called the left cerebral penduncle. The cerebral penduncles are two cylinder-like nerve bundles in the brain stem that act as a conduit for signals that control motor functioning throughout the body.  
After performing MVD of the left trigeminal nerve, Dr. Jannetta decompressed the patient’s cerebral penduncle by mobilizing and repositioning the offending artery. The results were stunning. By post-operative day five, the patient’s Parkinson’s symptoms, including severe tremor and rigidity, had disappeared.   She remained symptom free for 18 months, after which she suffered a full recurrence. A follow-up MRI scan showed new compression of the non-treated right cerebral penduncle by the opposite posterior cerebral artery.
Based on this case, Dr. Jannetta and his colleagues at AGH conducted a blinded MRI study analyzing the brains of 20 patients with Parkinson’s and 20 healthy control subjects. The study showed that 78 percent of the Parkinson’s Disease patients had visible arterial compression/distortion of one or both cerebral penduncles. 
Of the study’s 20 control subjects, just two had low grade compression of the cerebral penduncle and one of those was subsequently diagnosed with Parkinson’s.
“Though we clearly need to continue our research on a larger scale to substantiate this remarkable observation, the very idea that a manageable vascular abnormality in the brain may be a critical factor in disease onset and manifestation for some Parkinson’s patients is an extremely exciting possibility,” Dr. Jannetta said.
Parkinson’s affects more than one million people in the United States and despite significant advancements over the past several decades in uncovering the pathogenesis of the disease, conventional treatments provide symptomatic relief only.
Dr. Jannetta said his team’s data raises compelling questions that will be addressed in follow up studies: Is there a form of parkinsonism related to arterial compression of the cerebral penduncle? Does unilateral cerebral penduncle arterial compression cause unilateral disease only? Can it cause bilateral Parkinson’s Disease in time? Can MVD relieve parkinsonism and if so, will it be as safe and effective as seen in other diseases?  
A multi-center clinical trial to further explore the AGH team’s premise and is slated to begin later this year.
In addition to Dr. Jannetta, who serves as Emeritus Professor of Neurosurgery at AGH, other members of the study team included AGH neurosurgeons Donald Whiting, MD, Matthew Quigley, MD, and Joseph Hobbs, MD, neurologist Jon Brillman, MD, and neuro-radiologists Melanie Fukui, MD and Robert Williams, MD.
Dr. Jannetta and his colleagues at the AGH Jannetta Cranial Nerve Disorders Center, including neurosurgeon Khaled Aziz, MD, have performed more than 10,000 microvascular decompression surgeries.  
Dr. Aziz’s recent addition to the program has enabled Dr. Jannetta to expand his groundbreaking research into the role of vascular compression in a growing number of cranial nerve and brainstem syndromes, including hyptertension and diabetes. 
A landmark paper published by Dr. Jannetta in the August 2010 edition of Surgical Neurology International presented the first evidence that vascular compression of a section of the brain called the medulla oblongata is a factor in Type 2 diabetes.
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