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  • Title: Medullary Decompression by Sling Repositioning of Vertebral Artery with Operative Video.
    Author: Ascanio LC, Alturki AY, Griessenauer CJ, Motiei-Langroudi R, Kumar S, Ogilvy CS.
    Journal: World Neurosurg; 2017 Dec; 108():995.e5-995.e7. PubMed ID: 28893696.
    Abstract:
    BACKGROUND: Vascular compression of the medullary pyramid resulting in neurologic compromise is rare; therefore diagnosis is difficult and ultimately delayed. Most patients present with a combination of cranial nerve, autonomic, and/or motor and sensory dysfunction. Presentation with a single sign such as hemiparesis is rare. The low number of cases reported has made it impossible to define a standard treatment for this unusual disorder. CASE DESCRIPTION: Here, we present a patient with progressive left hemiparesis due to compression of the upper medulla by the vertebral artery, which was treated with repositioning of the artery using a sling. Clinical and radiologic features including upper medullary compression by the left vertebral artery with effacement of the left medullary pyramid and T2/fluid-attenuated inversion recovery signal changes in the right medulla are illustrated. The patient underwent a standard left retrosigmoid craniectomy for mobilization of the left vertebral artery with a Hemashield (Maquet Cardiovascular, San Jose, California, USA) sling (see video). Postoperatively, the patient had significant improvement of the left hemiparesis and follow-up imaging showed decompression of the medulla with edema reduction. CONCLUSIONS: Vascular decompression using a sling has proven to be a valuable option for treatment of symptomatic vascular brainstem compression.
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