On Surgical Treatment of Patients With Vertebrobasilar Insufficiency Associated With Kimmerle Anomaly

Abstract

Patients with vertebrobasilar insufficiency, which are frequent in neurological and neurosurgical practice, require a complex examination to reveal its ethiology and to perform a differential diagnostics. The study objective was to develop a diagnostic algorithm for detection of clinically significant forms of Kimmerle anomaly, and to introduce a new technique for surgical treatment under intraoperative monitoring of the vertebral artery decompression. When a patient with the Kimmerle anomaly shows a vertebrobasilar insufficiency, a comprehensive surgical policy includes a complex clinicalphysiological assessment of the vertebrobasilar basin (from vertebral arteries entrances up to the basilar artery and its branches). If any other pathology is excluded, the Kimmerle rings (foramen arcuale) are removed and hemodynamics in the vertebrobasilar basin is estimated by clinical and graphical Doppler methods.

Minimally invasive surgical treatment for Kimmerle anomaly

“…The main pathogenic factors for the development of clinical symptoms in patients with Kimmerle anomaly are as follows: extravasal compression of the vertebral artery, the long-term trauma of the vessel adventitia as well as irritation of the paravasal sympathetic nerves and branches of the occipital nerve. [ 7 9 ] The clinical symptoms of Kimmerle anomaly are variable: headache, dizziness, tinnitus, transient hearing and visual disorders, tiredness, sleep disturbances, unsteady gait, drop attacks, panic attacks, anxiety or asthma, numbness of hands, and seizures. [ 7 9 11 12 13 14 ] Such patients often receive ineffective symptomatic therapy for a long time in case timely visualization of the craniovertebral region (using CT or MRI) is not performed.…”

“…[ 7 9 ] The clinical symptoms of Kimmerle anomaly are variable: headache, dizziness, tinnitus, transient hearing and visual disorders, tiredness, sleep disturbances, unsteady gait, drop attacks, panic attacks, anxiety or asthma, numbness of hands, and seizures. [ 7 9 11 12 13 14 ] Such patients often receive ineffective symptomatic therapy for a long time in case timely visualization of the craniovertebral region (using CT or MRI) is not performed. All patients in our study were under the observation of a neurologist.…”

“…There are very few published papers concerning surgical treatment focusing on the removal of ponticuli posticus. [ 5 8 9 10 ] The authors used a routine midline approach with an incision from the occipital protuberance to the spinous process of the C3 vertebra with resection of the posterior arch of atlas or the posterior bony ridge of atlas from both sides. The highly efficient rate of symptom regression with surgical treatment is 90%.…”

“…The regression of the clinical signs of vertebrobasilar conflict was observed in 90% of operated patients. [ 5 8 9 10 ] There are no articles on minimally invasive surgical treatment of this pathology.…”