An easy adjustable method of ectatic vertebrobasilar artery transposition for microvascular decompression

Area of Science:

• Neurosurgery
• Vascular Surgery
• Neurology

Background:

• Microvascular decompression (MVD) for trigeminal neuralgia (TN) or hemifacial spasm (HFS) involving vertebral or basilar artery compression often results in incomplete cure.
• Ectatic vertebrobasilar artery systems pose challenges in MVD procedures.

Purpose of the Study:

• To introduce and evaluate an easily applied and adjustable method of vertebrobasilar artery transposition and fixation.
• To enhance the immediate surgical outcomes of MVD for TN and HFS caused by ectatic vertebrobasilar arteries.

Main Methods:

• Vertebrobasilar artery transposition using a vascular sling made of unabsorbable dural tape.
• Fixation of the artery-sling complex to the dura over the petrous bone using an aneurysm clip.
• Adjustable traction on the artery achieved through varying clip lengths or dural bridge levels.

Main Results:

• The technique was applied in 7 MVD cases with vertebral or basilar artery compression.
• High rates of symptom remission were observed: total remission in 4 patients (3 TN, 1 HFS), complete spasm freedom in 1 HFS patient within a week, and 80% improvement in another HFS patient at 3 months.
• No major surgical complications occurred; one patient experienced unexpected cure of refractory hypertension.

Conclusions:

• Vertebrobasilar artery transposition and fixation offers a safe and effective method for MVD.
• The technique provides surgeons with an easy and adjustable approach to manage complex vascular compressions.
• This method shows promise in improving MVD success rates and potentially addressing comorbid conditions.