Clin Exp Otorhinolaryngol.  2020 May;13(2):123-132. 10.21053/ceo.2019.00780.

Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia

• Huh G
• Bae YJ
• Woo HJ
• Park JH
• Koo JW
• Song JJ

• KMID: 2500284
• DOI: http://doi.org/10.21053/ceo.2019.00780

Abstract

Objectives
. Vertebrobasilar dolichoectasia (VBD), an elongation and distension of vertebrobasilar artery, may present with cranial nerve symptoms due to nerve root compression. The objectives of this study are to summarize vestibulocochlear manifestations in subjects with VBD through a case series and to discuss the needs of thorough oto-neurotologic evaluation in VBD subjects before selecting treatment modalities.
Methods
. Four VBD subjects with vestibulocochlear manifestations were reviewed retrospectively. VBD was confirmed by either brain or internal auditory canal magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Patient information, medical history, MRI/MRA findings, and audiometry or vestibular function tests were reviewed according to patient’s specific symptom.
Results
. Of the four subjects, three presented with ipsilesional sensorineural hearing loss (SNHL), three with paroxysmal recurrent vertigo, and two with typewriter tinnitus. The MRI/MRA of the four subjects revealed unilateral VBD with neurovascular compression of cisternal segment or the brainstem causing displacement, angulation, or deformity of the cranial nerve VII or VIII that corresponded to the symptoms.
Conclusion
. Vestibulocochlear symptoms such as SNHL, recurrent paroxysmal vertigo, or typewriter tinnitus can be precipitated from a neurovascular compression of the vestibulocochlear nerve by VBD. Because proper medical or surgical treatments may stop the disease progression or improve audio-vestibular symptoms in subjects with VBD, a high index of suspicion and meticulous radiologic evaluation are needed when vestibulocochlear symptoms are not otherwise explainable, and if VBD is confirmed to cause audiovestibular manifestation, a thorough oto-neurotologic evaluation should be performed before initial treatment.

Keyword

Sensorineural Hearing Loss; Hemifacial Spasm; Microvascular Decompression

Figure

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  Fig. 1. (A) Pure tone audiometry shows moderate low frequency sensorineural hearing loss on the left side. (B) Axial T2-volume, isotropic, turbo spin-echo acquisition (VISTA) image shows obvious angulation with posterior displacement of the left vestibulocochlear and facial nerves at the root entry/exit zone (arrow) due to neurovascular compression caused by dolichoectatic left distal vertebral artery. Dilated right side vertebrobasilar junction with dark signal intensity is caused by previous coil embolization. (C) Intracranial time-of-flight magnetic resonance angiography well demonstrates vertebrobasilar dolichoectasia with the basilar artery diameter of 4.6 mm, grade 2 height of the basilar artery bifurcation, and grade 1 lateral position of the basilar artery. (D) Pure tone audiometry 2 months after the surgery shows aggravated sensorineural hearing loss on the left side.

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  Fig. 2. (A) Axial T2-volume, isotropic, turbo spin-echo acquisition (VISTA) image shows indentation of the right vestibulocochlear and facial nerves at the cisternal segment (arrow) due to neurovascular compression caused by the right distal vertebral artery. (B) Intracranial time-of-flight magnetic resonance angiography demonstrates laterally displaced course of the distal vertebral artery. According to Smoker’s criteria, the diameter of basilar artery is 3.8 mm, and the grades for the height of the basilar artery bifurcation and lateral position of the basilar artery are all grade 2.

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  Fig. 3. Pure tone audiometries performed on initial visit (A) and 5 years later (B) reveal aggravating right-sided sensorineural hearing loss. (C) Bithermal caloric test conducted on initial visit showed a 33% weakness in the right side. (D) Axial T2-weighted images shows the dolichoectatic right distal vertebral artery causes severe posterior displacement of the right vestibulocochlear and facial nerves, probably causing neurovascular compression at the root entry/exit zones and cisternal segments (arrow). (E) Distended and tortuous vertebrobasilar artery is well depicted on the intracranial time-of-flight magnetic resonance angiography. SPV, slow phase velocity.

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  Fig. 4. (A) Pure tone audiometries (PTAs) shows left unilateral down-sloping hearing loss while normal hearing threshold on the right side. (B) Auditory brainstem response shows a significant prolongation of wave I–V interpeak interval of the left ear as compared with the right ear (interaural difference of 0.4 ms). (C, D) Axial T2-volume, isotropic, turbo spin-echo acquisition (VISTA) image shows dolichoectatic left distal vertebral artery (black arrows) and left anterior inferior cerebellar artery (white arrows) causing posterior displacement of left vestibulocochlear and facial nerves at the root entry/exit zones. AC, air conduction.

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