Microvascular Decompression of the Medulla: A Case Report and Review of the Surgical Management

This case study and review of surgical management highlights the efficacy of microvascular decompression (MVD) with transposition of the vertebral artery in alleviating symptoms of vertebral artery compression syndrome (VACS). VACS is a rare condition in which the vertebral artery exerts pathological compression on the medulla, leading to a spectrum of potentially debilitating neurological symptoms. While microvascular decompression (MVD) is a well-documented treatment for cranial nerve compression syndromes, its application in relieving medullary compression due to VACS remains less explored. A 49-year-old female presented with over 10 years of progressively worsening migraine headache with associated symptoms of dizziness, vertigo, blurry vision, diplopia, pulsatile tinnitus of the left ear, a sensation of a lump in her throat, hoarseness, left hemiparesis, and loss of balance. Preoperative imaging identified a tortuous, right intradural vertebral artery segment causing mass effect and deformity of the right ventral medulla. A surgical approach with MVD of the medulla and transposition of the vertebral artery led to significant symptomatic relief. A review of surgical treatment options for VACS showed MVD with transposition of the vertebral artery resulted in improved symptoms in all cases. MVD alone showed improved symptoms postoperatively, but there was a recurrence of symptoms in some cases. Patients treated non-surgically more often showed persistent symptoms. Advancing the management of VACS will continue to require expanding the evidence base through case reports and clinical studies, but MVD with transposition of the vertebral artery has been shown to be effective. By continuing to refine our understanding and approach, we can improve outcomes for patients afflicted by this condition.