PMC9479612_01
(a) Photograph of a patient demonstrating hemiatrophy of the tongue on the right side, (b, c) MRI of the brain (mode T1W-3D, T2W-3D). Visualized conflict of the vertebral artery and medulla 2 oblongata.
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F1
MRI revealed a dolichoectasia of the right VA, which severely compressed the medulla oblongata and roots (XII cranial nerve?) exiting the trunk at the level of the deformity [Figure 1]. During transposition, to reduce the stiffness of the main artery, temporary clipping of the vertebral artery was used for 7 min [Figures 3 and 4, Video 1].
Patient position.
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F2
We performed a right-sided "enough" lateral retrosigmoid craniotomy in the position of the patient on the left side [Figure 2].
Intraoperative picture: (a) wrapping the vertebral artery with a Teflon strip and (b) transposition the artery by fixing the cuff to the dura mater of the clivus with single sutures.
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F3
During transposition, to reduce the stiffness of the main artery, temporary clipping of the vertebral artery was used for 7 min [Figures 3 and 4, Video 1].
Images describing the technique of transposition the artery: - visualized conflict of arterial and neural structures, (b) making the cuffs of Teflon material, (c) arterial transposition by suturing the cuff to the dura mater, and (d) additionally interpositioned with Teflon gasket.
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F4
During transposition, to reduce the stiffness of the main artery, temporary clipping of the vertebral artery was used for 7 min [Figures 3 and 4, Video 1].
MRI of the brain after surgical intervention (a: T2W-axial, b: T2W-coronal). Transposition and interposition of the vertebral artery are visualized.
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F5
In the 1st day after the surgery, the patient underwent MRI of the brain, visualized the displaced vertebral artery without signs of brainstem compression, the right vertebral artery and other arteries of the posterior cranial fossa contrasted homogeneously, no arterial narrowing or deformities were observed [Figure 5].
MRI of the brain after 3 months (a: T2W-3D, b: T1W-3D). Visualized the displaced vertebral artery without signs of brainstem compression.
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F6