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Case Reports
. 2024 Jun 7;16(6):e61889.
doi: 10.7759/cureus.61889. eCollection 2024 Jun.

A Case With Twists and Turns: A Report of Vertebrobasilar Dolichoectasia

Mary Therese Thomas  1 , Jamie Campbell  1
Affiliations
Case Reports

A Case With Twists and Turns: A Report of Vertebrobasilar Dolichoectasia

Mary Therese Thomas et al. Cureus. .

Abstract

Vertebrobasilar dolichoectasia (VBD) is a rare anatomical abnormality of the vertebral artery system, defined as irregular expansion, elongation, and tortuosity of vertebral arteries. Anomalies of the vertebrobasilar artery can have a wide variety of clinical presentations, ranging from simple headaches to debilitating strokes. We present the case of an atypical presentation of VBD which mimicked trigeminal neuralgia by compressing the trigeminal nerve. There are currently no guidelines concerning the management of VBD, nor is there evidence of a definitive cure. This case invoked discussions among the medical team as to whether management should be medically or surgically focused, as well as long-term outcomes for patients with VBD. The superiority of medical versus surgical treatment of this issue is still a debated topic. This patient trialed medical management with dexamethasone and carbamazepine with no improvement in symptoms. He then underwent surgical gamma knife treatment but even this invasive measure was unsuccessful at relieving his symptoms. We hope that by presenting this case, we can display how the therapies available for VBD are limited and often unsuccessful in relieving the disease burden in patients with VBD.

Keywords: brain anatomy; microvascular decompression surgery; neurology and neurosurgery; neuroradiology; neurovascular compression; trigeminal nerve decompression; vascular ectasia; vertebrobasilar junction.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Dominant right vertebral artery crossing the midline to the confluence with the vertebral artery, with a return midline course of the basilar artery along the left ventral aspect of the brainstem resulting in mild compressive deformity.
Figure 2
Figure 2. Sagittal view of mild compressive deformity caused by the right vertebral artery.
Figure 3
Figure 3. Coronal view of mild compressive deformity caused by the right vertebral artery.
Figure 4
Figure 4. Clear dolichoectasia of the vertebral artery with a loop directed to the left toward the neurovascular complexes.
See this image and copyright information in PMC

References

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