Microvascular Decompression and Transposition of the 8th Cranial Nerve Using a Fenestrated Clip.

Autor: Turcotte EL; Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA., Patra DP; Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA., Abi-Aad KR; Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA., Welz ME; Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA., Weisskopf PA; Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA., Bendok BR; Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA. Electronic address: Bendok.bernard@mayo.edu.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2020 Mar; Vol. 135, pp. 233. Date of Electronic Publication: 2019 Dec 16.
DOI: 10.1016/j.wneu.2019.12.046
Abstrakt: Neurovascular compression is a potential, yet rare cause of vertigo and unilateral tinnitus. Despite the high success rate of microvascular decompression (MVD) in other vascular compression syndromes, the outcome reported after MVD of the vestibulocochlear nerve is variable. 1 , 2 The presence of combined symptoms of tinnitus and vertigo treated by MVD has demonstrated a higher predictive value for success. 3 In this video, we present the case of a 68-year-old male who presented with vertigo and tinnitus refractory to medical management and vestibular therapy. Audiologic evaluation was normal apart from mild sensorineural hearing loss. Vestibular testing was suggestive of uncompensated right peripheral vestibulopathy. Magnetic resonance imaging with fast imaging employing steady-state acquisition sequences revealed vascular compression by the right anteroinferior cerebellar artery (AICA) at the cisternal component of vestibulocochlear nerve. After a multidisciplinary discussion, a microvascular decompression was performed through a right retrosigmoid craniotomy. The AICA was mobilized off the vestibulocochlear nerve and was secured to the petrous dura using a fenestrated clip. Indocyanine green angiography with Glow-800 was conducted before and after AICA transposition to confirm adequate flow through the mobilized vessel. Postoperatively, the patient's vestibular symptoms improved significantly. This case demonstrates that microvascular decompression can provide a satisfactory outcome in patients with unilateral tinnitus and vertigo associated with vascular compression in appropriately selected cases (Video 1).
(Copyright © 2019. Published by Elsevier Inc.)
Databáze: MEDLINE
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