Bulbar Compression by the Vertebral Artery: Four Atypical Cases

Background: Symptomatic compression of the medulla oblongata and the pons by the vertebral artery is thought to be a rare condition; the literature pertaining to this condition consists merely of isolated case studies. Recent clinical experience suggests that this condition may be clinically under-appreciated and that patients with vascular compression of the brainstem are being misdiagnosed. Methods: Herein, we report on four surgical cases. All cases had a neuroradiological picture characterized by a megadolichovertebral artery pressing on the anterior bulbar surface. It should be emphasized that in all cases, the symptoms were initially attributed to associated pathologies (Chiari malformation, cervical spondylomyelopathy, cavernoma of the fourth ventricle, and hydrocephalus). Results: In the first few weeks after microvascular decompression of the bulb, the neurological picture of the patients showed clear signs of improvement with a considerable reduction in preoperative symptoms. After 12 months, the patients with the Chiari malformation, cervical spondylomyelopathy and hydrocephalus continued to improve, whereas the patient suffering from a cavernoma of the fourth ventricle roof suffered partial symptom relapse. Conclusions: Currently, the major body of literature on compression of the medulla oblongata and the pons by the vertebral artery is sparse and consists only of "case reports". However, we believe that for patients displaying a series of symptoms indicating bulbar compression in the presence of a megadolichovertebral artery, the microvascular decompression of the brainstem should also be considered. Categories: Neurosurgery