HFS primarily attributed to neurovascular compression at the root exit zone (REZ) of the CNVII, presents significant challenges in diagnosis and management. While Microscopic MVD remains the gold standard treatment, its efficacy in cases involving vertebrobasilar dolichoectasia (VBD) is less explored. This systematic review aimed to evaluate the safety and efficacy of endoscopic-assisted MVD (E-MVD) specifically in HFS secondary to VBD.

Comprehensive search using MeSH key words “Endoscopic”, “Microvascular Decompression”, “Vertebral Artery”, “Hemifacial spasm” across multiple databases was done. Following PRISMA guidelines, we identified six eligible studies. Descriptive statistics were used, qualitative and quantitative data were numerically expressed. Crude odds ratios of certain characteristics that may be attributable to comorbidities/post-operative complications were also determined. These were performed with a 95% confidence interval, p-value of <0.05 will be considered statistically significant.

Mean age was 53.63 years with female predominance. E-MVD demonstrated an 84.06% complete resolution rate, with partial resolution in 8.70% and no relief in 7.25% of cases. Transient facial palsy was the primary postoperative complication. Following factors pose increased risk for comorbidities/post-operative complications: age ≥ 60 years old (4.2500), male (1.1905), AICA involvement (3.7037) and left sided involvement (1.5750).

Comparison with traditional microscopic MVD reveals comparable success rates, with E-MVD offering enhanced visualization and potential reductions in complications. Challenges related to vertebral artery involvement and complex compression patterns are addressed more effectively with endoscopic techniques. While the learning curve for surgeons transitioning to endoscopic approaches exists, the benefits of minimally invasive procedures warrant further exploration and adoption.

Subclavian steal syndrome (SSS) is a manifestation of vertebrobasilar artery insufficiency due to stenosis of the proximal subclavian artery. It is a common vascular disorder; however, most patients are asymptomatic, and the disorder is commonly found incidentally during imaging. Nevertheless, some patients may present with arm ischemia or signs and symptoms of vertebrobasilar insufficiency, such as vertigo, dizziness, diplopia, ataxia, dysarthria, and syncopal episodes. We present a case of a male patient who presented with sudden onset dizziness, syncopal episodes, and blood pressure discrepancy between his arms. Diagnosis was a challenge, and the patient underwent several investigations, including basic bloodwork, electrocardiography (ECG), echocardiography, brain computed tomography (CT), and coronary CT angiography (CTA). Narrowing in the proximal left subclavian artery was found during coronary CTA, which confirmed the diagnosis of SSS.
Subclavian Steal Syndrome ; Syncope ; Angioplasty

No abstract available.
Cranial Nerve Diseases ; Cranial Nerves ; Hoarseness ; Vertebrobasilar Insufficiency ; Vocal Cord Paralysis

No abstract available.
Vertebrobasilar Insufficiency

No abstract available.
Drug-Eluting Stents ; Stents ; Vertebral Artery ; Vertebrobasilar Insufficiency

We report an unusual case of an 83-year-old man who was admitted with dizziness and repeated drop attacks. He was diagnosed with bilateral carotid artery occlusion and he underwent a left subclavian to left carotid bypass with ringed polytetrafluoroethylene graft. The patient's postoperative course was uneventful and no symptoms presented during a 6-month follow-up. Finally, we discuss on proper management of such patients.
Aged, 80 and over ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Artery, Common ; Carotid Artery, Internal ; Dizziness ; Follow-Up Studies ; Humans ; Pathology ; Polytetrafluoroethylene ; Syncope ; Transplants ; Vertebrobasilar Insufficiency

OBJECTIVE: To investigate the severity of blood steal and the hemodynamic profiles in patients with subclavian artery stenosis combined with vertebral artery stenosis. METHODS: A retrospective analysis was performed of transcranial Doppler (TCD) data from patients with subclavian artery stenosis (SAS) and concomitant unilateral/bilateral vertebral artery stenosis (VAS, >50%) or occlusion in our institution between February, 2014 and July, 2018.Thirty-seven patients with SAS combined with VAS (SAS+VAS) were reviewed for types of blood steal, peak systolic velocities of blood flow in affected subclavian artery and the contralateral vertebral artery, and the findings of hyperemia testing.These data were also reviewed for 39 SAS patients without VAS (control group) for comparison of blood steal and hemodynamic profiles. RESULTS: In SAS+VAS group, 5 patients showed no blood steal; blood steal in stage Ⅰ was found in 22 patients, stage Ⅱ in 7, and stage Ⅲ in 3, as compared to the numbers of 17, 12 and 10 in the control group, respectively (H=9.431, =0.002).The peak systolic velocity of the contralateral vertebral artery was 43.91±17.43 cm/s in SAS+VAS group, significantly lower than that in the control group (53.56±17.45 cm/s; = 629.5, =0.006).Hyperemia testing showed a significant difference in the negative rate between SAS+VAS group and the control group[35.1%(13/37) 7.7%(3/39);=8.603, =0.003). CONCLUSIONS SAS combined with VAS may lead to reduced compensatory blood flow in the contralateral vertebral artery to lessen the severity of subclavian steal syndrome.
Hemodynamics ; Humans ; Regional Blood Flow ; physiology ; Retrospective Studies ; Subclavian Steal Syndrome ; complications ; physiopathology ; Vertebral Artery ; physiopathology ; Vertebrobasilar Insufficiency ; complications ; physiopathology

Subclavian artery (SCA) perforation is a rare complication while performing SCA intervention. In our present report, a 73-year-old female, with stenosis of the left SCA and situs inversus, presented with exercise-induced left arm weakness. The SCA stenosis was treated with direct stenting with a balloon-expansible Express LD 10×25 mm stent. However, it caused iatrogenic SCA perforation and hemothorax. The perforation was sealed by endovascular repair with operator-modified Endurant II graft stent, which complicated with occlusion of left common carotid artery. And, the carotid artery was rescued by another stent. The graft stent, which was originally designed for abdominal aortic aneurysm, can be modified to suitable length and take as a rescue stent of large vessel with iatrogenic perforation. Due to strong radial force of graft stent, preservation of large side branches should been watched out.
Aged ; Aortic Aneurysm, Abdominal ; Arm ; Carotid Arteries ; Carotid Artery, Common ; Constriction, Pathologic ; Female ; Hemothorax ; Humans ; Situs Inversus ; Stents* ; Subclavian Artery* ; Subclavian Steal Syndrome ; Transplants*

OBJECTIVES: We investigated clinical significance of head shaking nystagmus (HSN) and perverted HSN (pHSN) in patients with peripheral and central vestibular disorders. METHODS: We reviewed medical records of 822 consecutive subjects who were referred to a dizziness clinic. We performed neurologic examination including video-oculography in darkness for 60 seconds before, during and for 100 seconds after head-shaking. HSN was considered to develop when post-head-shaking nystagmus last at least 5 beats with latency from end of head-shaking of no more than 5 seconds, and a velocity at least 3°/sec. RESULTS: In control group (n=45), there were observed spontaneous nystagmus (SN) in 2.2%, HSN in 17.8%, pHSN in 6.7%. In patients with peripheral vestibular disorder group (n=397), there were observed SN in 14.1%, HSN in 40.6%, pHSN in 9.8%. In patients with central vestibular disorder group (n=217), there were observed SN in 17.5%, HSN in 24.0%, pHSN in 13.4%. In unspecified dizziness group (n=208), there were observed SN in 1.9%, HSN in 13.0%, pHSN in 1.9%. pHSN was frequently observed in central vestibular disorders such as stroke, vestibular migraine, cerebellar ataxia, and vertebro-basilar insufficiency. However, pHSN was also observed at higher rate than expected in peripheral vestibular disorders including benign paroxysmal positional vertigo especially involving vertical canals, Meniere disease and even in unilateral vestibulopathy. CONCLUSIONS: Our results show that perverted HSN in dizzy populations was frequently observed not only in cases of central vestibular disorders but also in peripheral disorders. Perverted HSN can develop by any conditions that cause difference in vestibular velocity storage in vertical component of vestibular-ocular reflex.
Benign Paroxysmal Positional Vertigo ; Cerebellar Ataxia ; Darkness ; Dizziness ; Head ; Humans ; Medical Records ; Meniere Disease ; Migraine Disorders ; Neurologic Examination ; Reflex ; Reflex, Vestibulo-Ocular ; Stroke ; Vertebrobasilar Insufficiency ; Vertigo ; Vestibular Function Tests

A 37-year-old woman who had undergone coronary artery bypass grafting (CABG) surgery for left main and right coronary ostial lesions 2 years prior presented with angina and transient visual dimness. Computed tomography angiography showed a patent left internal mammary artery (LIMA) bypass graft and concentric narrowing with perivascular thickening around the arch vessels. The patient was diagnosed with Takayasu arteritis with coronary subclavian steal syndrome (CSSS). Thoracic angiography revealed severe stenosis of the left proximal subclavian artery (SCA) and reverse flow from the coronary artery to the distal left SCA via the LIMA graft. Successful percutaneous stenting of the left SCA was performed together with stenting of the right common carotid artery (CCA). The patient's symptoms were completely resolved. This case is informative since it shows that Takayasu arteritis can manifest as angina due to coronary ostial lesions and then can involve arch vessels, which can lead to CSSS in patients with CABG.
Adult ; Angiography ; Carotid Artery, Common ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Coronary-Subclavian Steal Syndrome* ; Female ; Humans ; Mammary Arteries ; Stents ; Subclavian Artery ; Takayasu Arteritis* ; Transplants