open access

Vol 52, No 4 (2018)
Case reports
Submitted: 2017-08-06
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Symptomatic medulla compression by vertebral artery

Leszek Lombarski, Przemysław Kunert, Marcin Skawiński, Marek Prokopienko, Zbigniew Lewandowski, Andrzej Marchel
DOI: 10.1016/j.pjnns.2018.03.005
·
Neurol Neurochir Pol 2018;52(4):519-527.

open access

Vol 52, No 4 (2018)
Case reports
Submitted: 2017-08-06

Abstract

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<0.05).

Abstract

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<0.05).

Get Citation

Keywords

Vertebral artery, Medulla oblongata, Neurovascular conflict, Microvascular decompression

About this article
Title

Symptomatic medulla compression by vertebral artery

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 52, No 4 (2018)

Pages

519-527

DOI

10.1016/j.pjnns.2018.03.005

Bibliographic record

Neurol Neurochir Pol 2018;52(4):519-527.

Keywords

Vertebral artery
Medulla oblongata
Neurovascular conflict
Microvascular decompression

Authors

Leszek Lombarski
Przemysław Kunert
Marcin Skawiński
Marek Prokopienko
Zbigniew Lewandowski
Andrzej Marchel

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