gms | German Medical Science

Objective: Symptomatic vascular compression of the medulla oblongata causing brainstem dysfunction is extremely rare. Only a few case reports documenting the clinical condition of patients, diagnostic features, and therapeutic options are available in the literature.

Methods: Together with the presented cases a Medline search revealed a total of 9 reports on patients with symptomatic brain stem compression by a vertebral artery. From these reports the observed symptoms comprise hypertension, hemiparesis, tetraparesis, hemihypesthesia, pyramidal tract signs, central sleep apnea and vertigo. Moreover, an overview of the various suggested and published microsurgical procedures is given. Based on the literature search basically 4 different microsurgical strategies are documented: vessel mobilization, vessel section with posterior fossa decompression, autologous material inlay with posterior fossa decompression, and lateral vessel retraction assisted with Gore-Tex.

Vascular compression causing brainstem deficits is particularly unusual in the young population. Two illustrative cases of young men with a symptomatic vertebral artery/brain stem conflict who were treated microsurgically with vascular decompression are additionally discussed in the present article. The history, diagnostic features, microsurgical treatment, and outcome of these patients are described in detail. As a conclusion these cases demonstrated that careful examination can serve to determine the diagnosis even in the young population, which can be treated successfully by microsurgery.

Conclusions: The present cases and the performed review try to provide an overview of the existent data on the variety of clinical, radiological, and surgical features in patients with symptomatic vascular brain stem compression.