Tomasello Francesco, Alafaci Concetta, Salpietro Francesco M, Longo Marcello
Department of Neurosurgery, University of Messina, Messina, Italy.
Neurosurgery. 2005 Jan;56(1 Suppl):117-24; discussion 117-24. doi: 10.1227/01.neu.0000146684.23593.b4.
Brainstem compression caused by vascular abnormalities has rarely been reported in the literature. We describe five cases of large ectatic vertebral artery causing compression and distortion of the medulla oblongata with pyramidal tract signs and low cranial nerve dysfunction. Microvascular decompression by retracting the vertebral artery and anchoring it to the dura has been the treatment of choice.
Five patients, four male and one female, presented with progressive myelopathic features and lower cranial nerve dysfunction, especially dysphonia and dysphagia. Four patients were affected by systemic arterial hypertension. Magnetic resonance imaging showed impingement of the right vertebral artery in three patients and the left vertebral artery in two patients, on the right and left lateral medulla, respectively. In two patients, hypoplasia of the contralateral vertebral artery was documented.
All patients underwent neurovascular decompression of the medulla oblongata. The ectatic and tortuous vertebral artery was detached from the medulla, shifted away, and repositioned by anchoring to the nearby dura mater using a Gore-Tex vascular slip. Postoperatively, all patients but one had improvement of their previous neurological symptoms.
Brainstem dysfunction caused by a tortuous ectatic vertebral artery might be less uncommon than expected. It should be considered a new distinct clinical entity, the real incidence of which needs to be carefully evaluated by an appropriate diagnostic protocol, which includes primarily magnetic resonance imaging with specific three-dimensional sequences. Awareness of this condition is necessary to ensure the appropriate treatment. Surgical microvascular decompression seems very effective.
血管异常导致的脑干受压在文献中鲜有报道。我们描述了5例因巨大扩张型椎动脉导致延髓受压和扭曲，伴有锥体束征和低颅神经功能障碍的病例。通过牵拉椎动脉并将其固定于硬脑膜进行微血管减压一直是首选治疗方法。
5例患者，4例男性，1例女性，表现为进行性脊髓病特征和低颅神经功能障碍，尤其是发音困难和吞咽困难。4例患者患有系统性动脉高血压。磁共振成像显示，3例患者右侧椎动脉、2例患者左侧椎动脉分别压迫右侧和左侧延髓外侧。2例患者对侧椎动脉发育不全。
所有患者均接受了延髓神经血管减压术。扩张迂曲的椎动脉从延髓分离，移位并通过使用戈尔特斯血管带固定于附近硬脑膜重新定位。术后，除1例患者外，所有患者先前的神经症状均有改善。
迂曲扩张型椎动脉导致的脑干功能障碍可能比预期的更为常见。应将其视为一种新的独特临床实体，其实际发病率需要通过适当的诊断方案仔细评估，该方案主要包括具有特定三维序列的磁共振成像。认识到这种情况对于确保适当治疗是必要的。手术微血管减压似乎非常有效。
