Microsurgical Strategies for the Treatment of Compression Neuropathies Secondary to Vertebrobasilar Dolichoectasia: From Simple Decompression to Sling Transposition.
Abducens Nerve Diseases
/ etiology
Adult
Aged
Brain Stem
Cranial Nerve Diseases
/ etiology
Decompression, Surgical
/ methods
Facial Nerve Diseases
/ etiology
Female
Glossopharyngeal Nerve Diseases
/ etiology
Hemifacial Spasm
/ etiology
Humans
Male
Medulla Oblongata
Microsurgery
/ methods
Middle Aged
Trigeminal Neuralgia
/ etiology
Vertebrobasilar Insufficiency
/ complications
Arterial transposition
Basilar artery
Ectatic
Microvascular decompression
Myelopathy
Radiculopathy
Vertebral artery
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 11 2019
01 11 2019
Historique:
received:
06
05
2018
accepted:
25
11
2018
pubmed:
28
12
2018
medline:
7
10
2020
entrez:
28
12
2018
Statut:
ppublish
Résumé
Vertebrobasilar artery dolichoectasia may result in neural element compression anywhere along its course within the cervical region, the craniocervical junction or in the posterior fossa. The clinical syndromes most often observed include cranial neuropathy, bulbar dysfunction, myelopathy and cervical radiculopathy. When indicated, the operative techniques utilized to address vertebrobasilar artery dolichoectasia must be individually tailored, can be technically challenging, and have been rarely expounded. To share selected cases that demonstrate the variety of pathological states caused by vertebrobasilar artery dolichoectasia as well as our experience in managing this condition. Here we review examples of pathological impingement of neural elements compressed by ectasia within the vertebrobasilar arterial system throughout its anatomic course. The surgical techniques we have employed to alleviate the compression, including simple decompression as well as sling-assisted arterial transposition, are described. The evolution and refinement of our transposition technique are detailed. A wide range of pathological conditions may result from compression of neural structures throughout the course of the vertebrobasilar system. Compression of cervical nerve roots, the spinal cord, brainstem, and cranial nerves can be seen. Microsurgical management may be indicated in selected cases with gratifying results. Pathological compression of neural structures throughout the course of the vertebrobasilar system should be recognized. When indicated, microsurgical decompression must be tailored to the individual symptomology and the unique anatomic relationship in each case with the potential to prevent neurological worsening and, in many cases, improve functional outcome.
Sections du résumé
BACKGROUND
Vertebrobasilar artery dolichoectasia may result in neural element compression anywhere along its course within the cervical region, the craniocervical junction or in the posterior fossa. The clinical syndromes most often observed include cranial neuropathy, bulbar dysfunction, myelopathy and cervical radiculopathy. When indicated, the operative techniques utilized to address vertebrobasilar artery dolichoectasia must be individually tailored, can be technically challenging, and have been rarely expounded.
OBJECTIVE
To share selected cases that demonstrate the variety of pathological states caused by vertebrobasilar artery dolichoectasia as well as our experience in managing this condition.
METHODS
Here we review examples of pathological impingement of neural elements compressed by ectasia within the vertebrobasilar arterial system throughout its anatomic course. The surgical techniques we have employed to alleviate the compression, including simple decompression as well as sling-assisted arterial transposition, are described. The evolution and refinement of our transposition technique are detailed.
RESULTS
A wide range of pathological conditions may result from compression of neural structures throughout the course of the vertebrobasilar system. Compression of cervical nerve roots, the spinal cord, brainstem, and cranial nerves can be seen. Microsurgical management may be indicated in selected cases with gratifying results.
CONCLUSION
Pathological compression of neural structures throughout the course of the vertebrobasilar system should be recognized. When indicated, microsurgical decompression must be tailored to the individual symptomology and the unique anatomic relationship in each case with the potential to prevent neurological worsening and, in many cases, improve functional outcome.
Identifiants
pubmed: 30590732
pii: 5262356
doi: 10.1093/ons/opy391
doi:
Types de publication
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
481-490Informations de copyright
Copyright © 2018 by the Congress of Neurological Surgeons.