Method and apparatus for treatment of neurogenic diabetes mellitus, and other conditions

#1. Field of the Invention

#This invention relates to the field of neurosurgery, in particularly, a neurosurgical treatment for neurogenic disorders and, more specifically, to a neurosurgical method for the treatment of neurogenic conditions, including diabetes mellitus, by microvascular decompression of the medulla oblongata and viscera-related cranial nerves.

#2. Background Art

#FIG. 1 is a basilar view of the brain illustrating the blood vessels and cranial nerves at the base of the brain.

#FIG. 2 is a top view of a cross-section of a normal medulla oblongata at the root entry zone of the cranial nerve X.

#FIG. 3 is a top view of the cross-section in FIG. 2 showing vascular compression of the right ventrolateral medulla.

#The invention herein provides a method and devices for treating a neuroendocrine disease that is caused or exacerbated by vascular compression of the brainstem and the associated cranial nerves. By initiating and maintaining decompression of the relevant neural tissue, the diminished neuroendocrine servomechanisms can be encouraged to regain sufficient functioning as to effect the elimination or long term amelioration of the target neuroendocrine disease, e.g., NIDDM.

#In one embodiment of the present invention, it is preferred to treat NIDDM by effecting microvascular decompression of the right ventrolateral medulla oblongata, and the associated ninth and tenth cranial nerves (Cranial IX and Cranial X. respectively) using microsurgical techniques. Access to a subject's medulla and cranial nerves can be obtained by performing, for example, a retromastoid craniectomy, followed by a pericerebellar procedure which includes transection of the meninges and traversal of the cerebellum to the medulla oblongata. With the vertebral-basilar arteries thus visualized, the surgeon can perform a microvascular decompression of those pulsatile vessels which are compressing, or even grooving, the surfaces of the medulla and cranial nerves.

#FIG. 1 is a basilar view of a brain 1 showing parallel views of the blood vessels at the base of the brain and the cranial nerves. Visible from this view are medulla oblongata 2, basilar artery 3, and the bifurcated vertebral artery 4. A relevant branch of basilar artery 3 is anterior inferior cerebellar artery (AICA) 5, and of vertebral artery 4 is posterior inferior cerebellar artery (PICA 6). The left portion of cerebellum 7 is shown, and the right portion is removed to show occipital lobe 8. Other visible neural structures include Cranial IX, nerve 9 and Cranial X, nerve 10. FIG. 1 shows that arteries 3-6, and their branches, are quite proximate to, if not in contact with, medulla oblongata 2. As an individual ages, and as heredity dictates, all arteries in the brain, including arteries 3-6, tend to enlarge. In some cases, such as with neurogenic NIDDM, arteries 3-6, alone or in combination, can compress the surface of the medulla oblongata 2, near the root entry of nerves 9 and 10, and may cause grooving of the medullary tissue. Because of the pulsatile nature of the blood flow through arteries 3-6, the compression tends to be pulsatile compression. It is believed that pulsatile compression of the right ventrolateral medulla oblongata 2 causes the degradation of the glucose regulatory mechanism that acts in concert with the subject's internal milieu.