Peri-Arterial Neural Dissection During Adrenal Surgery Provides a Denervation-Like Benefit in Hypertension Control.

BACKGROUND

Peri-arterial neural tissue surrounding the renal artery contributes to sympathetic overactivity in hypertension. During adrenal surgery, surgical peri-arterial neural dissection may interrupt these fibers and exert a renal denervation-like effect. Whether this maneuver improves postoperative blood pressure control remains unclear.

METHODS

We retrospectively reviewed 127 hypertensive patients who underwent adrenal surgery between January 2022 and March 2025. According to intraoperative findings, patients were classified into a surgical peri-arterial neural dissection group or a nondissection group. After 1:2 manual matching by age, sex, and hypertension duration, 54 patients were included. Postoperative hypertension remission and changes in antihypertensive medication use, quantified by the defined daily dose, were assessed. Multivariable logistic regression was used to explore factors associated with postoperative nonremission. Renal and adrenal function markers were compared between groups.

RESULTS

The surgical peri-arterial neural dissection group had a higher remission rate than the nondissection group (50.0% versus 16.1%; P=0.008). Surgical peri-arterial neural dissection was independently associated with lower odds of postoperative nonremission (odds ratio, 0.150 [95% CI, 0.030-0.744]; P=0.020), supporting its potential role in improving postoperative blood pressure control. Patients in the dissection group showed greater reductions in antihypertensive medication use (median change in defined daily dose, -1.0 versus 0.0; P=0.006). Creatinine, blood urea nitrogen, cortisol, and adrenocorticotropic hormone levels were similar between groups.

CONCLUSIONS

Surgical peri-arterial neural dissection performed during adrenal surgery was associated with improved postoperative blood pressure control and reduced medication burden without evidence of impaired renal or adrenal function.