J Cerebrovasc Endovasc Neurosurg.  2019 Sep;21(3):158-162. 10.7461/jcen.2019.21.3.158.

Rotational vertebral artery syndrome treated via an anterior approach and selective decompression only

• Kang JH
• Im SB
• Jeong JH
• Shin DS

• KMID: 2465246
• DOI: http://doi.org/10.7461/jcen.2019.21.3.158

Abstract

We present the case of a 38-year-old male who complained of repeated dizziness and syncope. Rotational vertebral artery syndrome (RVAS) was diagnosed via videonystagmoraphy (VNG), computed tomography angiography (CTA) and three-position digital subtraction angiography (DSA). In the neutral position, CTA and DSA revealed left vertebral artery (VA) stenosis at the C2 transverse foramen and right VA hypoplasia. When the head was turned to the right, the blood flow stopped at the C2 level. The bony structure around the VA at the C2 transverse foramen was decompressed via an anterior surgical approach, and the symptoms resolved. This case present the precise stenotic point evaluation by three-position DSA is crucial for the planning of surgical treatment.

Keyword

Anterior decompression; Nystagmus; Posterior circulation infarction; Rotational vertebral artery syndrome; Videonystagmography

MeSH Terms

Adult
Angiography
Angiography, Digital Subtraction
Constriction, Pathologic
Decompression*
Dizziness
Head
Humans
Male
Syncope
Vertebral Artery*

Figure

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  Fig. 1 Videonystagmography revealed no nystagmus in the neutral position (A) or when the head was turned to the left (B). Right-beating nystagmus (black arrow) with a down-beat component was observed when the head was turned to the right (C).

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  Fig. 2 The posteroanterior view of three-dimensional-reconstruction computed tomography angiography revealed left vertebral artery stenosis at the C2 transverse foramen (white arrow).

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  Fig. 3 Diffusion and T2 FLAIR magnetic resonance imaging shows a tiny acute ischemic infarction in the right cerebellum (right arrow).

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  Fig. 4 Neutral. The anteroposterior view of left vertebral artery (VA) angiography with the head in the neutral position revealed left VA stenosis at the C2 transverse foramen. Left turn. The lateral view of left VA angiography when the head was turned to the left revealed that the stenotic VA at C2 became wider than in the neutral position. Right turn. The lateral view of left VA angiography when the head was turned to the right showed that blood flow decreased at the C3–4 level (black arrow) and stopped at the C2 level (white arrow).

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  Fig. 5 A) Preoperative computed tomography (CT) three-dimensional (3D)-reconstruction image. B) The postoperative CT 3D-reconstruction image showed that the anterior portion of the transverse foramen had been removed; the foramen was thus widened while preserving the articular facet (black arrow).

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