Symptomatic medulla compression by vertebral artery
| Autor: | Marcin Skawiński, Andrzej Marchel, Leszek Lombarski, Marek Prokopienko, Zbigniew Lewandowski, Przemysław Kunert |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Vertebral artery Microvascular decompression Microvascular Decompression Surgery 03 medical and health sciences 0302 clinical medicine medicine.artery Vertebrobasilar Insufficiency medicine Humans Vertebrobasilar insufficiency Stroke Vertebral Artery Medulla Medulla Oblongata medicine.diagnostic_test business.industry Magnetic resonance imaging 030206 dentistry medicine.disease Magnetic Resonance Imaging Diffusion Tensor Imaging Hemiparesis Surgery Neurology (clinical) Radiology medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Neurologia i Neurochirurgia Polska. 52:519-527 |
| ISSN: | 0028-3843 |
| Popis: | Objective Vertebral artery medulla compression syndrome (VAMCS) is a very rare condition manifesting as different neurological focal deficits. The case of a 36-year-old male with symptomatic brainstem compression by vertebral artery (VA) treated by means of microvascular decompression (MVD) and a review of the literature is presented. Case report On admission, a 36-year-old patient presented with hypoalgesia, hypothermesthesia and hemiparesis on the left side. Magnetic resonance imaging (MRI) of the head disclosed the right VA loop compressing the ventrolateral medulla and excluded other entities such as brain tumor, stroke and multiple sclerosis. Since displacement and significant compression of the right pyramidal tract was confirmed by diffusion tensor imaging (DTI), neurovascular compression syndrome was diagnosed. The patient underwent MVD of the medulla using a Gore-Tex implant as a separating material via the right far-lateral approach. The left hemiparesis and hemisensory loss remitted rapidly after the procedure. The post-procedural neurological improvement was maintained at one year follow-up. Based on a review of the literature, a total of 33 cases of surgically treated VAMCS has been reported so far. Conclusion VAMCS should be considered as the cause of neurological deficits when other pathological entities are ruled out. In symptomatic conflict of the VA with the medulla, microvascular decompression using a Gore-Tex implant can be an effective method of treatment. Nevertheless, a statistical analysis on all reported cases showed favorable results using the VA repositioning technique when compared with MVD (success rate 91% vs. 58%, p |
| Databáze: | OpenAIRE |
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