Accepted Manuscript Repositioning Technique for the Decompression of Symptomatic Dolichoectatic Vertebrobasilar Pathology: A Comprehensive Review of Sling Characteristics and Surgical Experiences Long Wang, MD, PhD, Li Cai, MD, Hai Qian, MD, PhD, Jae-Sang Oh, MD, Rokuya Tanikawa, MD, Xiang’en Shi, MD, PhD PII:
S1878-8750(18)32759-1
DOI:
https://doi.org/10.1016/j.wneu.2018.11.200
Reference:
WNEU 10884
To appear in:
World Neurosurgery
Received Date: 25 October 2018 Revised Date:
20 November 2018
Accepted Date: 21 November 2018
Please cite this article as: Wang L, Cai L, Qian H, Oh J-S, Tanikawa R, Shi X’e, Repositioning Technique for the Decompression of Symptomatic Dolichoectatic Vertebrobasilar Pathology: A Comprehensive Review of Sling Characteristics and Surgical Experiences, World Neurosurgery (2018), doi: https://doi.org/10.1016/j.wneu.2018.11.200. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Repositioning Technique for the Decompression of Symptomatic Dolichoectatic Vertebrobasilar Pathology: A Comprehensive Review of Sling Characteristics
RI PT
and Surgical Experiences
Long Wang,a,b,# MD, PhD, Li Cai,c,d MD, Hai Qian,a MD, PhD, Jae-Sang Oh,e MD,
Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University,
Beijing, China b c
M AN U
a
SC
Rokuya Tanikawa,b MD, Xiang’en Shi,a,f MD, PhD
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
Department of Neurosurgery, The First Affiliated Hospital of University of South
China, Hengyang, China
Arkansas Neuroscience Institute, St. Vincent Hospital, Little Rock, Arkansas, United
States e
TE D
d
Department of Neurosurgery, Soonchunhyang University Cheonan Hospital,
EP
Cheonan, Republic of Korea f
AC C
Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing,
China
#
Corresponding Authors
Long Wang, MD, PhD Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, No. 50, Yikesong Rd, Haidian District, Beijing, 100093
ACCEPTED MANUSCRIPT E-mail:
[email protected] Tel.: +86-10-62856737
RI PT
Funding Acknowledgments This study was funded by the Beijing Municipal Natural Science Foundation
AC C
EP
TE D
M AN U
Beijing (Grant No. Z161100000516019 to X.S.)
SC
(Grant No. 7161005 to X.S.) and Science and Technology Commission Foundation of
ACCEPTED MANUSCRIPT Long Wang et al. World Neurosurgery Abstract
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Objective: The repositioning of a dolichoectatic vertebrobasilar artery for arterial decompression
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has been extensively utilized in the clinical setting. This study aims to describe and summarize
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the technical characteristics and clinical results of the sling technique.
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Methods: The terms “dolichoectatic aneurysm”, “dolichoectasia”, “ectasia” and
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“megadolichoectasia” were used to search for pertinent articles related to the VBA territory.
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Articles related to the “decompression”, “repositioning”, “transposition”, “anchoring”, “pexy”
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and “sling” techniques were screened, collected and summarized by the junior author (L.W.).
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Results: Twenty pertinent papers involving 59 cases were identified. The sling repositioning
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techniques were divided into the following 4 subtypes: suture-lasso, vasculopexy, clip-lasso and
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wrap-sling. Overall, 59.3% (35/59) of the patients were treated by the wrap-sling technique, and
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among these cases, Gore-Tex grafts were the most common sling material. Of the cases with
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reported postoperative characteristics, all patients except one experienced complete or significant
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remission of symptoms. Although 18.6% (11/59) of the patients developed complications, the
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rate of adverse effects decreased to 3.6% (2/55) during the long-term follow-up period (mean,
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40.4 months; range, 2.1-168 months), and the outcomes were unremarkable in 98.2% (54/55) of
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the patients.
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Conclusions: The excellent surgical outcomes and durable long-term results suggest that the
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repositioning technique is highly effective in resolving symptoms related to the compression of
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dolichoectatic vertebrobasilar pathology. The wrap-sling technique may be the preferred option
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due to the simultaneous symptom relief and lower rate of temporary complications. However,
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cranial nerve manipulation should be meticulously implemented to avoid permanent negative
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effects.
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ACCEPTED MANUSCRIPT Long Wang et al. World Neurosurgery 1
Key Words: clip repositioning, dolichoectasia, dolichoectatic aneurysm, ectatic vertebrobasilar
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artery, sling repositioning, vasculopexy
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ACCEPTED MANUSCRIPT Long Wang et al. World Neurosurgery 1
Introduction Dolichoectatic vertebrobasilar artery (DVBA) has long been recognized as an uncommon
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vasculopathy characterized by arterial dilation/enlargement/elongation or aneurysm expansion.1-3
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Due to the absence of uniform diagnostic criteria, other names, including dolichoectasia,
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megadolichoectasia, ectatic vertebrobasilar artery (VBA) and vertebrobasilar (VB) ectasia, have
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been applied to this disorder.1,4 The prevalence of DVBA ranges from 0.05% to 5.8%,5-7 and this
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vascular disorder can be directed posteriorly or laterally, impinging on the brainstem and cranial
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nerves and causing compression syndrome (Figure 1).4,8 The following clinical features have
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been well described: (1) an assortment of cranial nerve (CN) dysfunctions manifesting as
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trigeminal neuralgia (TN), sixth nerve palsy, hemifacial spasm (HFS), glossopharyngeal
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neuralgia (GN), swallowing difficulty (dysphagia), dysphonia, and cough; (2) brainstem
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syndromes manifesting as headache, vertigo, diplopia, dizziness, hemiparesis, gait disturbance,
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hearing problems, possible downbeat nystagmus, and hypertension; and (3) cervicomedullary
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compression manifesting as neck stiffness, quadriparesis and ataxia.1,2,4,9-23 The incidence of
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trigeminal nerve compression secondary to DVBA was estimated to be 1.59%-5.8%,17,24-29 while
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in
