Top

Published in:

01-04-2016 | Case Report - Vascular

Vertebral artery dolicoectasia with brainstem compression: role of microvascular decompression in relieving pyramidal weakness

Authors: Nishanth Sadashiva, Dhaval Shukla, Dhananjaya I. Bhat, Bhagavatula Indira Devi

Published in: Acta Neurochirurgica | Issue 4/2016

Abstract

Vertebral artery dolicoectasia (VAD) can cause brainstem compression and dysfunction. Reports of pyramidal tract involvement by brainstem compression and the surgical benefits and its long-term results are sparsely reported. We hereby report three cases of medullary compression by VAD causing pyramidal weakness. Two patients with bilateral compression with quadriparesis did not want surgical treatment and were still disabled at 58 months and 50 months of follow-up, respectively. One patient with unilateral medullary compression with hemiparesis underwent microvascular decompression using Teflon sling retraction. This patient was relieved of symptoms and is asymptomatic at 14-month follow-up. This report emphasizes the need of surgical decompression in cases of brainstem compression by VAD with caution about appropriate case selection.

Ball BG, Krueger BR, Piepgras DG (2011) Anomalous vertebral artery compression of the spinal cord at the cervicomedullary junction. Surg Neurol Int 2:103CrossRefPubMedPubMedCentral

Flemming KD, Wiebers DO, Brown RD Jr, Link MJ, Huston J 3rd, McClelland RL, Christianson TJ (2005) The natural history of radiographically defined vertebrobasilar nonsaccular intracranial aneurysms. Cerebrovasc Dis 20:270–279CrossRefPubMed

Hongo K, Kobayashi S, Hokama M, Sugita K (1993) Vertebral artery section for treating arterial compression of the medulla oblongata. Case report. J Neurosurg 79:116–118CrossRefPubMed

Hongo K, Nakagawa H, Morota N, Isobe M (1999) Vascular compression of the medulla oblongata by the vertebral artery: report of two cases. Neurosurgery 45:907–910CrossRefPubMed

Ikeda K, Nakamura Y, Hirayama T, Sekine T, Nagata R, Kano O, Kawabe K, Kiyozuka T, Tamura M, Iwasaki Y (2010) Cardiovascular risk and neuroradiological profiles in asymptomatic vertebrobasilar dolichoectasia. Cerebrovasc Dis 30:23–28CrossRefPubMed

Kim P, Ishijima B, Takahashi H, Shimizu H, Yokochi M (1985) Hemiparesis caused by vertebral artery compression of the medulla oblongata. Case report. J Neurosurg 62:425–429CrossRefPubMed

Nakahara Y, Kawashima M, Matsushima T, Kouguchi M, Takase Y, Nanri Y, Yakusiji Y (2014) Microvascular decompression surgery for vertebral artery compression of the medulla oblongata: 3 cases with respiratory failure and/or dysphagia. World Neurosurg 82(535):e511–e536

Ozcan TA, Meral H, Ulukok MD, Serce AG, Yucel G (2013) A case of vocal cord paralysis secondary to vertebral artery dolichoectasia: a rare presentation. Turk Neurosurg 23:688–689PubMed

Passero SG, Rossi S (2008) Natural history of vertebrobasilar dolichoectasia. Neurology 70:66–72CrossRefPubMed

10.

Roh JH, Koo YS, Jang SH, Park MH (2008) Neurological picture. Medulla compression caused by vertebral artery dolichoectasia. J Neurol Neurosurg Psychiatry 79:222CrossRefPubMed

11.

Salvi F, Mascalchi M, Bortolotti C, Meletti S, Plasmati R, Rubboli G, Stecchi S, Villari N, Calbucci F, Tassinari CA (2000) Hypertension, hyperekplexia, and pyramidal paresis due to vascular compression of the medulla. Neurology 55:1381–1384CrossRefPubMed

12.

Schobel HP, Frank H, Naraghi R, Geiger H, Titz E, Heusser K (2002) Hypertension in patients with neurovascular compression is associated with increased central sympathetic outflow. J Am Soc Nephrol 13:35–41PubMed

13.

Takano S, Saitoh M, Miyasaka Y, Fujii K, Takagi H (2001) A case report of hemiparesis due to compression of the medulla oblongata by an elongated vertebral artery. No Shinkei Geka 29:247–251PubMed

14.

Ubogu EE, Chase CM, Verrees MA, Metzger AK, Zaidat OO (2002) Cervicomedullary junction compression caused by vertebral artery dolichoectasia and requiring surgical treatment. Case report. J Neurosurg 96:140–143CrossRefPubMed

15.

Wolters FJ, Rinkel GJ, Vergouwen MD (2013) Clinical course and treatment of vertebrobasilar dolichoectasia: a systematic review of the literature. Neurol Res 35:131–137CrossRefPubMed

Title: Vertebral artery dolicoectasia with brainstem compression: role of microvascular decompression in relieving pyramidal weakness
Authors: Nishanth Sadashiva
Dhaval Shukla
Dhananjaya I. Bhat
Bhagavatula Indira Devi
Publication date: 01-04-2016
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 4/2016
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-016-2715-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Vertebral artery dolicoectasia with brainstem compression: role of microvascular decompression in relieving pyramidal weakness

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2016

Stress during neurosurgery: no need to worry?

Clinical management of pineal cysts: a worldwide online survey

Restoration of ulnar nerve motor function by pronator quadratus motor branch: an anatomical study

Hemodynamic alterations after stent implantation in 15 cases of intracranial aneurysm

Giant aggressive chondrosarcoma of the calvarium: a rare entity and its differentials

Comparison of surgical exposure and maneuverability associated with microscopy and endoscopy in the retrolabyrinthine and transcrusal approaches to the retrochiasmatic region: a cadaveric study