Vertebrobasilar Dolichoectasia Causing An Optic Tract Syndrome

Endovascular Stent Implantation in the Treatment of Vertebrobasilar Dolichoectasia

Vertebrobasilar dolichoectasia (VBD) is a rare disease in clinic, with an incidence of 0.06% and 5.8%. It is a progressive vascular disease caused by the dilatation, tortuosity, and prolongation of vertebral and basilar arteries caused by a variety of factors. VBD can lead to hemodynamic changes, ischemic stroke, compression symptoms due to vasodilation, neurological dysfunction, hydrocephalus, subarachnoid hemorrhage, and other clinical manifestations. However, because the condition of VBD is complex and changeable, the treatment of VBD is not uniform. With the development of vascular intervention, especially the development of stent technology, it may become an effective method for the treatment of VBD. Two patients with VBD were treated with endovascular stent implantation.

Optic Disc Cupping Due to Dolichoectatic Internal Carotid Artery Optic Nerve Compression

BACKGROUND

To determine whether significant compression of the optic nerve by the internal carotid artery (ICA) can produce an optic neuropathy with optic disc cupping that resembles glaucoma in patients without elevated intraocular pressure (IOP).

METHODS

This was a retrospective case series of patients referred to neuro-ophthalmology for a possible nonglaucomatous optic neuropathy. Patients were included in the study if they had preserved visual acuity, optic disc-related visual field defects, optic nerve cupping, IOP less than 21 mm Hg, open angles, and unequivocal radiological compression of the ipsilateral optic nerve by an intracranial blood vessel.

RESULTS

Three patients were included with a mean age of 56.3 (range 29-82) years. Patient 1 was a 58-year-old man incidentally noted to have left optic nerve cupping on a routine examination. He had an inferior arcuate defect and the left prechiasmatic optic nerve was elevated and compressed by a tortuous left ICA. Patient 2 was a 29-year-old man with a normal-tension glaucoma (NTG) diagnosis for 7 years in the right eye treated with latanoprost. He had a superior greater than inferior arcuate defect and there was vascular compression of the optic nerve between the supraclinoid ICA and A1 segment of the anterior cerebral artery. Patient 3 was an 82-year-old woman with an NTG diagnosis for 10 years who had progression of her visual field defects despite low IOPs. MRI showed mass effect on the right optic nerve by a dolichoectatic right supraclinoid ICA.

CONCLUSIONS

Significant compression of the optic nerve by a normal, tortuous, or dolichoectatic ICA may result in an optic neuropathy with optic disc cupping that resembles glaucoma.

[Microvascular decompression in trigeminal neuralgia following vertebrobasilar dolichoectasia]

OBJECTIVE

To analyze our own results with literature data and substantiate microvascular decompression in patients with trigeminal neuralgia (TN) following vertebrobasilar dolichoectasia (VBD).

MATERIAL AND METHODS

A total of 504 patients with TN underwent surgery in 1998-2018. Patients with TN following VBD were included into a retrospective study. There were 4 men and 10 women aged 66 years (range 51-80). Outcomes were evaluated using BNI (Barrow Neurological Institute) scale. PubMed database was used for literature review.

RESULTS

TN caused by VBD was diagnosed in 2.8% of patients. Left-sided trigeminal pain was observed in 10 patients, right-sided - in 4 cases. One patient had concomitant hemifacial spasm. MVD followed by shielding of trigeminal nerve root with shredded Teflon was performed in all patients. We did not perform fixation of vertebrobasilar vessels. In one case, open partial trigeminal nerve root rhizotomy was done in addition to MVD. All patients had pain-free early postoperative period. There were no deaths or major complications. There was transient cranial nerve dysfunction lasting no more than three months (facial numbness - 1, IV nerve dysfunction - 1, VI nerve dysfunction - 1, transient partial facial palsy (House-Brackmann II) - 2, hipoacusia - 2 patients). There was no facial pain recurrence in our group. Mean follow-up period was 5.5 years (range 6 months - 16 years).

CONCLUSION

MVD is an effective option in the treatment of TN following VBD. In these cases, operation is technically more difficult compared to MVD with intact vessels. However, surgery is much more effective than all the available alternatives. The possibilities of vessel transposition in VBD with or without fixation are limited and ineffective. Teflon wool interposition at the points of conflict is an effective and sufficient technique.

Vertebrobasilar dolichoectasia causing homonymous hemianopia: a case report and review of the literature

A 73-year-old man was diagnosed with an incidental finding of right homonymous hemianopia and presyncopal spells. Magnetic resonance imaging revealed a vertebrobasilar dolichoectasia (VBD) with compression of the left optic tract. VBD is defined as an elongation and dilatation of the basilar artery. Only a few cases have been described in the literature of VBD causing optic tract compression. So far no treatment option has been described for these cases, while surgical options exist for compressions of other cranial nerves, most commonly the trigeminal nerve. VBD can further cause stroke or cerebral and subarachnoid bleeding.