Vertebral artery compression of the medulla oblongata: A benign radiological finding?

To the best of our knowledge, no study has documented the natural history of rostral medullary compression of the vertebral artery (RMCVA) as radiological finding. The aim of this study was to explore it.

A total of 57 patients with RMCVA and not presenting symptoms of medullary compression syndrome were enrolled. These participants underwent cerebral magnetic resonance imaging with contrast, and 19 of them who were followed for 5.7 ± 1.9 years (range: 3.0-10.3 years) were analyzed in detail. For comparison, clinical courses of two other patients with vertebrobasilar dolichoectasia (VBDE) were presented.

RMCVA was well delineated in all 57 patients. In the 19 patients analyzed, RMCVA was found in 17 sides on the right and 15 on the left. Moreover, the ventrolateral medulla was the most frequent compression site, and it was found in 69% of cases, with 84.2% presenting as mild compression and 15.8% as considerable compression. During the follow-up period, no patients showed neurological deterioration or radiological progression. In contrast, the two VBDE patients demonstrated both neurological and radiological progressions during the follow-up period.

Unlike VBDE, RMCVA seems to be a benign condition without progression, even when with a considerable compression. Degree of the compression in RMCVA may not be relevant to the patient's neurological status.