Surgical management of vertebrobasilar insufficiency due to pathology of the second-third segments of the vertebral artery.

AIM OF THE STUDY

To determine efficacy of surgical management for vertebrobasilar insufficiency (VBI) associated with pathological passage of the vertebral artery (VA) within the bone canal.

MATERIALS AND METHODS

Over the period from 2003 to 2008, a total of twenty-five patients with no effect of conservative therapy during 6 months were subjected to reconstruction of the VA in the 3rd segment. The access to the artery was obtained in a manner similar to that used in reconstruction of the carotid arteries, without intersecting the nodding muscle. All the patients were prior to surgery subjected to neuropsychological testing, extra-and intracranial ultrasonographic study with the positional tests, angiography (NMR or digital subtraction angiography). Doppler ultrasonography of the bypass graft, neuropsychological testing, and angiography by the indications were repeated on postoperative day 7 and 3 months after surgery.

RESULTS

In the postoperative period according to the VBI scale and Tinneti scale, we revealed significant improvement of the indices on day 7. The improvement of the cognitive functions was not statistically significant (P >0.05). Transcranial Doppler ultrasonography with the De Kleijn test at baseline revealed that five (21%) patients had a complete arrest of blood circulation along one of the VAs, with a decrease in the blood flow along the basilar artery by more than 50%. In the remaining cases, the difference in the volumetric characteristics of the blood stream along the basilar artery averagely amounted to 42.0 +/- 5.4%. Ultrasonographic study performed both in the short- and long-term postoperative periods (on day 7, at 3 months) did not reveal any significant decrease in the bloodflow along the basilar artery during the positional test.

CONCLUSIONS

The external-carotid--vertebral transposition improves the blood circulation in the posterior cranial fossa. An operative intervention performed on the 3rd segment of the vertebral artery removes symptomatology of VBI as early as in the immediate postoperative period. Poor surgical outcomes in hypoplasia of the vertebral artery require further studies aimed at investigating the possibilities of surgical correction of VBI in patients presenting with the vascular pathology concerned.