The relationship of the anterior inferior cerebellar artery diameter and the vascular loop type with the clinical manifestations in vascular loop syndrome: a clinical radiologic study

Abstract

Objective: Tinnitus and vertigo are common audiovestibular symptoms in the population. Many diseases can lead to the appearance of these symptoms, but the exact cause can often not be determined. It has been suggested that compression of the cranial nerves by vascular structures may be the cause of various clinical manifestations. This is known as microvascular compression syndrome. Some studies have stated that vascular compression syndromes are a serious pathology, while many studies have argued that vascular compression is only a radiological finding. We aimed to contribute to the literature on vascular compression syndrome and vascular loop types, which is still a controversial topic, and to determine the location of the diameter change in the anterior inferior cerebellar artery in the compression syndrome. Material and Method: Patients who underwent a Magnetic Resonance Imaging (MRI) examination of Temporal Bone due to a complaint of tinnitus or vertigo were retrospectively examined. The complaints of the patients, the diameters of the anterior inferior cerebellar artery (AICA) and the types of vascular loop were evaluated in the high resolution 3D fast imaging employing steady-state acquisition (FIESTA) sequence, according to the CHAVDA classification. The statistical relationship between the age of the patients, anterior inferior cerebellar artery diameters and vascular loop types and their clinical manifestations was investigated. Results: A total of 52 patients were enrolled in the study, of which 28 (53.8%) were male and 24 (46.2%) were female. The mean age of all patients was 47.58±18.734 years. The mean right AICA diameters of the patients were 1.10±0.206 mm, the mean left AICA diameter was 1.11±0.253 mm. Type 1 in 29 patients, type 2 in 12 patients, type 3 vascular loop in 4 patients were observed for the right side, while type 1 in 29 patient, type 2 in 12 patients, and type 3 in 7 patients were observed for the left side. There was no significant difference between vascular loop and tinnitus on the right and left (p=0.705; p=0.335, respectively). There was no significant difference between the right vascular loop and the left vascular loop and the vertigo (p>0.999; p=0.425, respectively). There was no significant difference between the right tinnitus, left tinnitus and vertigo in terms of the diameters of the right and left AICA in the patients (p=0.782; p=0.762; p=0.408; p=0.915, respectively). Conclusion: Vascular compression syndromes are clinical conditions that show symptoms over cranial nerves. Although the vascular loop syndromes originating from AICA have been discussed a lot recently, it is seen that there is no definite opinion. In our study, no association of AICA diameter and vascular loop type with clinical findings was found.

Keywords

• Vascular loop
• anterior inferior cerebellar artery
• vertigo
• tinnitus

Vasküler loop sendromunda anterior inferior serebellar arterin çapı ve vasküler loop tipinin klinik bulgular ile ilişkisi: klinik radyoloji çalışması

Abstract

Amaç: Tinnitus ve vertigo popülasyonda yaygın görülen audiovestibuler semptomlardandır. Pek çok hastalık bu belirtilerin ortaya çıkmasına yol açabilir. Ancak kesin sebep çoğu zaman belirlenemez. Kranial sinirlerin vasküler yapılar tarafından kompresyonunun çeşitli klinik bulguların sebebi olabileceği öne sürülmüştür. Bu mikrovasküler kompresyon sendromu olarak bilinir. Bazı çalışmalar vasküler kompresyon sendromlarının ciddi bir patoloji olduğunu ifade ederken pek çok çalışmada ise vasküler kompresyonun sadece radyolojik bir bulgu olduğu savunulmaktadır. Halen tartışmalı bir konu olan vasküler kompresyon sendromu ve vasküler loop tipleri hakkında literatüre katkı sağlamayı, anterior inferior serebellar arterdeki (AICA) çap değişikliğinin kompresyon sendromundaki yerini belirlemeyi amaçladık. Gereç ve Yöntem: Tinnitus veya vertigo şikayeti nedeniyle Temporal Kemik Manyetik Rezonans Görüntüleme tetkiki yapılan hastalar retrospektif olarak incelendi. Hastaların şikayetleri, anterior inferior serebellar arter’in çapı ve vasküler loop tipi CHAVDA sınıflandırmasına göre yüksek rezolüsyonlu 3 boyutlu fast imaging employing steady-state acquisition (FIESTA) sekansında değerlendirildi. Hastaların yaşı, anterior inferior serebellar arter çapları ve vasküler loop tipleri ile klinik bulguları arasındaki istatistiksel ilişki araştırıldı. Bulgular: Çalışmaya toplamda 52 hasta alınmış olup bu hastaların 28’i (%53,8) erkek, 24’ü (%46,2) kadındır. Tüm hastaların yaş ortalaması 47,58±18,734 yıldır. Hastaların sağ AICA çaplarının ortalaması 1,10±0,206 mm, sol AICA çap ortalaması 1,11±0,253 mm’dir. Sağ taraf için 29 hastada tip 1, 12 hastada tip 2, 4 hastada tip 3 vasküler loop gözlenirken sol taraf için ise 29 hastada tip 1, 12 hastada tip 2, 7 hastada tip 3 gözlenmiştir. Sağda ve solda vasküler loop ile tinnitus arasında anlamlı bir farklılık bulunmamıştır (sırasıyla p=0,705; p=0,335). Sağ vasküler loop ve sol vasküler loop ile vertigo arasında anlamlı bir farklılık bulunmamıştır (sırasıyla p>0,999; p=0,425). Hastalarda sağ tinnitus, sol tinnitus ve vertigo görülüp görülmemesi arasında sağ ve sol AICA çapları açısından anlamı farklılık bulunmamıştır (sırasıyla p=0,782; p=0,762; p=0,408; p=0,915). Sonuç: Vasküler kompresyon sendromları kranial sinirler üzerinden belirti gösteren klinik durumlardır. AICA kaynaklı vasküler loop sendromları son zamanlarda oldukça tartışılsa da kesin bir kanaat elde edilmediği görülmektedir. Çalışmamızda AICA çapının ve vasküler loop tipinin klinik bulgularla birlikteliği saptanmamıştır.

Keywords

• Vasküler loop
• anterior inferior serebellar arter
• vertigo
• tinnitus

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