Brainstem compression syndrome caused by vertebrobasilar dolichoectasia: microvascular repositioning technique.

Dra. Cristina Birlem Bleil – Rua Henrique Scliar 284 91220-520 Porto Alegre RS Brasil. E-mail: [email protected] Vertebrobasilar dolichoectasia (VBD) is an anatomic variant that consists of enlargement and dilatation, often associated with a tortuous and elongated vessel. The anomaly is probably due to a marked thinning of the internal elastica lamina and media, most likely as a consequence of prolonged systemic arterial hypertension. It accounts for approximately 3 to 5% of all cerebellopontine mass lesions. A variety of clinical syndromes have been related due to pulsatile compression by the aberrant vessel: cerebellar dysfunction, hydrocephalus, ischemic stroke, transient or permanent motor deficits, central sleep apnea, trigeminal neuralgia, as well as brain stem compression syndrome. Microvascular decompression surgery was introduced in the 1960s and was initially used to treat trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia. Lately, it was used to treat brainstem dysfunction caused by an ectatic vessel. Nowadays, microvascular decompression with repositioning of the ectatic vessel is a new technique that has been used successfully. The purpose of this study is to report and discuss a rare case of brain stem compression syndrome caused by vertebrobasilar dolichoectasia successfully treated with microvascular decompression repositioning technique and documented by computed tomography angiography (CTA) and magnetic resonance imaging (MRI).