Vertebrobasilar insufficiency due to osseous abnormalities оf the craniovertebral junction

Abstract

Objective. To study pathogenetic significance of bone abnormalities of the craniovertebral junction (CVJ) for the insuf- ficiency of the vertebrobasilar circulation by analyzing the long-term outcomes of surgical treatment and comparing them with preoperative data of patients. Material and Methods. Long-term results of surgical treatment of 49 patients operated on for bone abnormalities of the CVJ in the period from 1985 to 2013 who had strongly proved clinical and instrumental signs of vertebrobasilar insufficiency (VBI) and responded the questionnaire. Decompression of the brain and vertebral arteries was performed through transpharyngeal approach developed by authors. Eleven patients with Kimmerle anomaly underwent resection of abnormal bone bridges on the arch of the atlas and arteriolysis of the vertebral artery. Results. Surgery for craniovertebral abnormalities provided the improvement in 84.2 % of operated patients. Excellent and good results were observed in 12 patients (75.0 %) with unstable abnormalities and in 6 patients (27.3 %) with stable abnormalities (p < 0.01). All patients with Kimmerle anomaly got good to excellent treatment outcomes. Conclusion. Decompression of the brain and vertebral arteries through transpharyngeal approach is a pathogenetically jus- tified method of treatment of patients with vertebrobasilar insufficiency due to craniovertebral abnomalities.

Keywords

• craniovertebral abnormalities
• vertebrobasilar insufficiency
• kimmerle anomaly