1199. Repositioning Technique for Decompression of Symptomatic Dolichoectatic Vertebrobasilar Pathology

Authors: Long Wang, MD, PhD (Phoenix, AZ)

Introduction: Repositioning of a dolichoectatic vertebrobasilar artery for arterial decompression has been extensively utilized in the clinical setting. The current study aims to described and summarize the technical characteristics and clinical results of sling technique. Methods: The terms “dolichoectatic aneurysm”, “dolichoectasia”, “ectasia” and “megadolichoectasia” were used to search for pertinent articles related to the VBA territory. The “decompression”, “repositioning”, “transposition”, “anchoring”, “pexy” and “sling” techniques were screened, collected and summarized by the junior author (L.W.). Results: Twenty pertinent papers involving 59 cases were identified. Sling repositioning techniques were divided into 4 subtypes: suture-lasso, vasculopexy, clip-lasso and wrap-sling. Among them, 59.3% (35/59) of cases were treated by the wrap-sling technique and, among them, Gore-Tex grafts were the most common sling material. “Lasso” anchoring to the skull base dura, especially the petrous dura was used more frequently than other tacking sites. Of the cases with reported postoperative characteristics, all patients except one experienced complete or significant remission of symptoms. Although 18.6% (11/59) of cases developed complications, the rate of adverse effects decreased to 3.6% (2/55) during long-term follow-up (mean, 40.4 months; range, 2.1-168 months), and outcomes were unremarkable in 98.2% (54/55) of patients. Conclusion: Excellent surgical outcomes with durable long-term results suggest that repositioning technique is highly effective in resolving symptoms related to the compression of dolichoectatic vertebrobasilar pathology. Wrap-sling technique may be the preferred option due to the analogous symptom relief and lower rate of temporary complications. However, cranial nerves manipulation should be meticulously implemented to avoid permanent negative effects.