Severe vertebrobasilar dolichoectasia as a cause of obstructive hydrocephalus

Abstract

Rationale: Dolichoectasia of the vertebrobasilar artery is a vascular anomaly characterized by marked elongating, widening, and tortuosity of the arteries. Although this anomaly is usually asymptomatic, it may present with ischemic symptoms or mass effect involving brainstem or cranial nerves. Patient concerns: A 52-year-old male was admitted with headache and visual field defect. Diagnoses: Computed tomography and magnetic resonance imaging showed noncommunicating hydrocephalus due to vertebrobasilar dolichoectasia. Interventions: The patient underwent right-side ventriculoperitoneal shunt. Outcomes: The patient's symptoms improved gradually, although visual symptoms persisted. Lessons: Neurosurgeons need to keep in mind vertebrobasilar dolichoectasia as a rare cause of obstructive hydrocephalus for accurate diagnosis and swift treatment.

Fully Endoscopic Microvascular Decompression for Trigeminal Neuralgia Caused by Vertebrobasilar Artery: A Case Series Review: 2-Dimensional Operative Video

“…[25][26][27] Vertebrobasilar dolichoectasia is a rare but well-recognized vascular anomaly characterized by tortuosity, elongation, enlargement, and dilatation of the VBA and subsequent hemodynamic changes. 28 It can lead to a wide array of symptoms, including cranial neuropathies such as TN and HFS. 29 Thus, VBA-induced TN is more likely to be associated with HFS than other causes of TN.…”

Endoscopic third ventriculostomy for noncommunicating hydrocephalus by vertebrobasilar dolichoectasia: A case report

“…[2,14] Two mechanisms have been reported for noncommunicating hydrocephalus with VBD. [1,6,9] One is the true obstruction of CSF flow due to compression of the third ventricle or cerebral aqueduct while the other is impairment of CSF communication due to the combination of increased CSF pulse pressure and impairment of outward CSF flow by countercurrent pulsations of the basilar artery. [13] e previous reports showed that bilateral or unilateral VP shunt placement has been performed for the hydrocephalus with VBD.…”

“…[13] e previous reports showed that bilateral or unilateral VP shunt placement has been performed for the hydrocephalus with VBD. [1,3,6,9,10,15,16] However, even though ETV is more effective than shunt surgery for noncommunicating hydrocephalus because of fewer complications and lower mortality, there are no reports about ETV for hydrocephalus with VBD. [4,8] We experienced a case of noncommunicating hydrocephalus with VBD and performed ETV with a good long-term outcome.…”

“…[7,12,14] ere are some reports of ventriculoperitoneal (VP) shunting for noncommunicating hydrocephalus with VBD but, recently, endoscopic third ventriculostomy (ETV) is more commonly used. [1,[4][5][6] However, there are no reports of ETV for noncommunicating hydrocephalus with VBD. Here, we report a case of noncommunicating hydrocephalus with VBD treated by ETV with an emphasis on precautions and endoscopic features.…”