Vestibulocochlear Symptoms Caused by Vertebral Arter Compression at the Cerebellopontine Angle: Is There Any Relationship?

Year 2021, Volume: 5 Issue: 3, 176 - 183, 22.12.2021

Fulya Özer , Cem Özer , Ozlem Alkan , Haluk Yavuz

https://doi.org/10.46332/aemj.804567

Abstract

Purpose:To evaluate the vestibulocochlear symptoms and audiological findings in patients with radiologically detected vascular compression of the abnormally localized vertebral artery at the cerebellopontine angle.

Materials and Methods: Patients with magnetic resonance imaging (MRI) with an image of vascular compression due to an angulated or lateralized vertebral artery included. The degree of vascular compression based on imaging was noted by the radiologist. The patients’ medical records were independently reviewed and the presence of tinnitus, hearing loss, vertigo and the results of mean hearing thresholds on pure tone average (PTA), speech discrimination (SD) mean scores, V latency, and I-V interpeak latency on auditory brainstem responses (ABR) were noted.

Results: The close relationship was detected in 28 MR scans. The degree of compression was categorized as point compression on the nerve in 5 patients, longitudinal compression on the nerve in 17, and contact as vascular loop or indentation in the nerve in 6. There were no differences between vascular compression of vertebral artery and ipsilateral symptom patterns in all groups. In the
groups, ipsilateral results of PTA, SD and ABR were found abnormal compared with contralateral results but failed to show statistical significance. 

Conclusion: The results suggest that there was no significant clinical value of vascular compression of the vertebral artery on the cochleovestibular nerve. In patients with unexplained hearing loss, dizziness and tinnitus complaints, deciding on the cause of compression of the vertebral artery at the cerebellopontine angle and discussing the necessity of decompression surgery will only be possible with larger patient series.

Keywords

vascular compression, vertebral artery, MR imaging, cochleovestibular signs

Supporting Institution

This study was approved by Baskent University Institutional Review Board and supported by Baskent University Research Fund.

Project Number

(Project no: KA 16/310)

Thanks

Authors, thanks to Dr. Can Alper Cagici for their contribution.

Serebellopontin Açıda Vertebral Arter Kompresyonuna Bağlı Olası Vestibulokoklear Semptomlar: Aralarında Bir İlişki Var Mı?

Abstract

Amaç: Serebellopontin açıda (SPA) anormal lokalize vertebral arterin vasküler kompresyonu radyolojik olarak tespit edilen hastalarda vestibülokoklear semptomlar ve odyolojik bulgularla olan ilişkisini değerlendirmektir.

Araçlar ve Yöntem: Manyetik rözanansgörüntüleme (MRG) sekizinci sinirde açılanmış veya lateralize olmuş vertebral artere bağlı tespit edilen vasküler kompresyon görüntüsüne sahip hastalar dahil edilmiştir. Görüntülemeye göre vasküler kompresyonun derecesi radyolog tarafından not edilmiştir. Bu hastaların hastane kayıtları ise bir kulak burun boğaz uzmanı tarafından bağımsız olarak incelenmiştir. Hastaların tinnitus, işitme azlığı, başdönmesi şikayetlerinin yanısıra saf ses odyometride işitme eşikleri (Pure tone average, PTA), konuşmayı ayırt etme skorları (speech discrimination, SD) ve işitsel beyinsapı cevaplarından (auditory brain stem response, ABR) V.dalga mutlak latans ve I-V arası latans değerleri not edilmiştir.

Bulgular: 28 MRG kaydında vertebral arter ile 8. kranial sinir kompleksi arası yakın ilişki not edilmiştir. Damarın pozisyonu incelendiğinde; 5 hastada nokta pozisyon; 17 hastada yatay olarak temasta; 6 hastada sinir kompleksi üzerinde sarmal yapmış olarak değerlendirilmiştir. Bu 3 grupta vertebral arterin pozisyonu ile ipsilateral vestibülokoklear semptomlar arasında bir ilişkiye rastlanmamıştır. Gruplarda kompresyonun olduğu ipsilateral PTA, SD, ABR sonuçlar daha anormal tespit edilmekle beraber istatistiksel olarak bir anlam bulunmamıştır.

Sonuç: Bu çalışmanın bulguları, vertebral arterin vasküler kompresyonu ile kokleavestibüler semptom ve odyolojik bulgular arasında anlamlı bir ilişki olmadığını göstermektedir. Nedeni klinik olarak açıklanamayan işitme kaybı, baş dönmesi ve tinnitus şikâyeti olan hastalarda, vertebral arterin serebellopontin açıda kompresyonunun neden olduğuna karar verebilmek ve dekompresyon cerrahisinin gerekliliğini tartışabilmek ancak daha geniş hasta serileri ile mümkün olabilecektir.

Keywords

vasküler kompresyon, vertebral arter, MR görüntüleme, işitme, tinnitus

Project Number

(Project no: KA 16/310)

References

• 1. Janetta PJ. Neurovascular compression in cranial nerve and systemic disease. Ann Surg. 1980;192(4):518-525.
• 2. Huh G, Bae YJ, Woo HJ, Park HJ, Koo JW, Song JJ. Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia. Clin Exp Otorhinolaryngol. 2020;13(2):123-132.
• 3. Nowe V, Ridder DD, Van de Heyning PH. Does the location of a vascular loop in the cerebellopontine angle explain pulsatile and non-pulsatile tinnitus? EurRadiol. 2004;14(12):2282-2289.
• 4. Liu CH, Lin SK, Chang YJ. Cochlear vertebral entrapment syndrome: a case report. Eur J Radiology. 2001;40(2):147-150.
• 5. Titlic M, Vrebalov-Cindro V, Lahman-Doric M. Hemifacial spasm in vertebrobasilar dolichoectasia. Acta Neurol Belg. 2006;106(106):23-25.
• 6. Grasso G, Alafaci C, Passalacqua M. Landmarks for vertebral artery repositioning in bulbar compression syndrome: anatomic and microsurgical nuances. Oper. Neurosurg. 2005;56(1):160-164.
• 7. Chadha NK, Weiner GM. Vascular loops causing otological symptoms: a systemic review and metaanalysis. ClinOtolaryngol. 2008;33(1):5-11.
• 8. Carpentier J, Lynch N, Fisher A. MR imaged neurovascular relationships at the cerebellopontine angle. ClinOtolaryngol. 1996;21(4):312-316.
• 9. Mcdermott AL, Dutt SN, Irving RM. Anterior inferior cerebellar artery syndrome: fact or fiction. ClinOtolaryngol. 2003;28(2):75-80.
• 10. Makins AE, Nikolopoulos TP, Ludman C. Is there correlation between vascular loops and unilateral auditory symptoms? The Laryngoscope. 1998;108(11):1739-1742.
• 11. Kanzaki J, Ogawa K. Internal auditory canal vascular loops and sensorineural hearing loss. ActaOtolaryngol. 1988;105(447):88-93.
• 12. Casselman JW, Kuhweide R, Deimling M. Constructive interference in steady state-3D DFT MR imaging of the inner ear and cerebellopontine angle. Am J Neuroradiology. 1993;14(1):47-57.
• 13. Glasscock ME, Gulya AJ. Surgery of the Ear. 5th Ed. Canada; BC Decker Inc;2003.
• 14. Yasargil MG. Microsurgery vol 1. Stuttgart; Georg Thime Verlag; 1984.
• 15. Alonso F, Kassem M W, Iwanaga J, et al. AnteriorInferiorCerebellarArteriesJuxtaposedwiththeInternalAcousticMeatusandTheirRelationshiptotheCranialNerve VII/VIII Complex. Cureus. 2017;9(8):e1570.
• 16. Bayazit YA, Goksu N. Tinnitus and Neurovascular compression ORL J. Otorhinolaryngol. Relat. Spec. 2008;70(3):209.
• 17. Applebaum EL, Valvassori GE. Auditory and vestibular system findings in patients with vascular loops in the internal auditory canal. Ann OtolRhinolLaryngol. 1984;92(4):63-69.
• 18. Di Stadio A, Dipetro L, RalliM,et al. Loop characteristics and audio-vestibular symptoms or hemifacial spasm: is there a correlation? A multiplanar MRI study. EurRadiol. 2020;30(1):99-109.
• 19. Hennirici M, Rautenberg W, Schwartz A. Transcranial Doppler ultrasound for the assessment of intracranial arterial flow velocity-part 2: evaluation of intracranial arterial disease. Surg Neurol. 1987;27(6):523-532.
• 20. Schwaber MK, Whetsell WO. Cochleovestibular nerve compression syndrome: histopathology and theory of pathophysiology. Laryngoscope. 1992;102(9):1030-1036.
• 21. AbreuJunior L, Kuniyoshi CH, Wolosker BA, et al. Vascular loops in the anterior inferior cerebellar artery, as identified by magnetic resonance imaging, Bras. 2016;49(5):300-304.
• 22. Huang Q, Tang J: Age-related hearing loss or presbycusis. Eur Arch Otorhinolaryngol. 2010;267(8):1179-1191.
• 23. DeRidder D, Ryu H, Moller AR, Nowe V, Van de Heyning P, Verlooy J. Functional anatomy of the cochlear nerve and its role in microvascular decompressions for tinnitus. Neurosurgery. 2004;54(2):427-433.
• 24. Tutar H, Sahin M, Tutar VB, Bayazit YA, Göksu N. Vascular compression syndromes: our 24 year endoscope-assisted microvascular decompression experiences. Kulak Burun Boğaz İhtis. Derg. 2014;24(1):6-10.
• 25. Vanden Berge MJC, van Dijk JMC, Posthumus IA, Smidt N, van Dijk P, Free RH. Microvascular decompression of the cochleovestibular nerve for treatment of tinnitus and vertigo: a systematic review and meta-analysis of individual patient data. J Neurosurg.2017;127(3):588-601.
• 26. Nussbaum ES, Goddard JK, Lowary J, Robinson JM, Hilton C, Nussbaum LA. Delayed sudden hearing recovery after treatment of a large vertebral artery aneurysm causing hearing loss and imbalance: a case report. Br J Neurosurg. 2019;3:1-5.