RESUMO
BACKGROUND: It is well known that brainstem dysfunction may be caused by vascular compression of the medulla oblongata (MO). However, only a limited number of reports have found microvascular decompression (MVD) surgery to be an effective treatment for symptomatic patients with MO dysfunction, such as essential hypertension, pyramidal tract signs, dysphagia, and respiratory failure. CASE DESCRIPTION: This report describes 3 patients with vertebral artery compression of MO who presented with respiratory failure and/or dysphagia. MVD surgery using the transcondylar fossa approach was effective in relieving patient symptoms. CONCLUSIONS: Although the pathogenic mechanisms of symptomatic vertebral artery compression of MO remain unclear, we should recognize that MVD surgery is effective for selected patients with brainstem dysfunction. The transcondylar fossa approach and the stitched sling retraction technique are appropriate in MVD surgery to relieve vertebral artery compression of MO.
Assuntos
Transtornos de Deglutição/etiologia , Bulbo/cirurgia , Cirurgia de Descompressão Microvascular/métodos , Insuficiência Respiratória/etiologia , Insuficiência Vertebrobasilar/cirurgia , Adulto , Idoso , Feminino , Humanos , Doença por Corpos de Lewy/complicações , Tratos Piramidais/patologia , Resultado do Tratamento , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/complicaçõesRESUMO
BACKGROUND: In the surgeries of the upper part of the cerebellopontine angle (CPA), the petrosal vein (PV) is an obstacle, and the resection of the PV sometimes causes postoperative complications such as cerebellar hemorrhagic infarction. On the other hand, it can be an anatomical landmark during the surgery. We have used three-dimensional (3D) CT images for preoperative evaluation. We, herein, report 4 cases of CPA lesions. METHOD: The PV was imaged with neighboring structures using CT and a workstation. We paid attention especially to the vein of the cerebellopontine fissure (VCPF). RESULT: The four cases include one case of trigeminal neuralgia, two meningiomas and one case of acoustic schwannoma. 3D CT images showed (1) the anatomical formation such as course of the PV, (2) relationship to the neighboring structures of the tumors, (3) expectation of complications after sacrificing the PV. By observing the preoperative 3D CT images, we were able to plan safety operative approaches and procedures. CONCLUSION: 3D CT images of the PV are very useful for preoperative evaluation of surgery in CPA lesions.
