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

Year 2021, , 124 - 130, 21.12.2021
https://doi.org/10.47582/jompac.1027717

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.

Supporting Institution

YOK

Project Number

YOK

Thanks

DR TUĞÇE ŞİRİNOĞLU, DR DİLARA PATAT.

References

  • Nowé V, De Ridder D, Van de Heyning PH, et al. Does the location of a vascular loop in the cerebellopontine angle explain pulsatile and non-pulsatile tinnitus? Eur Radiol 2004; 14: 2282-9.
  • Aksoy S, Fırat Y, Alpar R. The tinnitus handicap inventory: A study of validity and reliability. Int Tinnitus J 2007; 13: 94-8.
  • Demir E, Beyazal Celiker F, Celiker M, Aydin Balaban G, Dursun E. The effect of vascular loop in the tinnitus severity. Akd Med J 2020; 2: 249-55.
  • Wu D, Zheng Y, Chen Z, Ma Y, Lu T. Further validation of the Chinese (Mandarin) Tinnitus Handicap Inventory: comparison between patient-reported and clinicalinterviewed outcomes. Int J Audiol 2018; 57: 440-8.
  • Formánek M, Migaľová P, Krulová P, et al. Combined transcranial magnetic stimulation in the treatment of chronic tinnitus. Ann Clin Transl Neurol 2018; 5: 857-64.
  • Zidan, M.A., Almansor, N. Presence of vascular loop in patients with audio-vestibular symptoms: is it a significant finding? Evaluation with 3-tesla MRI 3D constructive interference steady state (CISS) sequence. Egypt J Radiol Nucl Med 2020; 51, 114.
  • McDermott AL, Dutt SN, Irving RM, Pahor AL, Chavda SV. Anterior inferior cerebellar artery syndrome: fact or fiction. Clin Otolaryngol Allied Sci 2003; 28: 75-80.
  • Ryu H, Yamamoto S, Sugiyama K, et al. Neurovascular compression syndrome of the eight cranial nerve: what are the most reliable diagnostic signs? Acta Neurochir (Wien) 1998; 140: 1279–86.
  • Ryu H, Yamamoto S, Sugiyama K, et al. Can the site of compression explain the symptoms? Acta Neurochir (Wien) 1999; 141: 495–301.
  • De Ridder D, De Ridder L, Nowe´ V, et al. Pulsatile tinnitus and the intrameatal vascular loop: why do we not hear our carotids? Neurosurgery 2005; 57: 1213–17.
  • Lee H. Neuro-otological aspects of cerebellar stroke syndrome. J Clin Neurol 2009; 5: 65-73.
  • Schultze, F. Linksseitiger facialiskrampf in folge eines aneurysma der arteria vertebralis sinistra. Archive Pathol Anat 1875; 65: 385–91.
  • Dandy WE. Concerning the cause o f trigeminal neuralgia. Am J Surg 1934; 24: 447-55.
  • Jannetta PJ. Cranial nerve vascular compression syndromes (other than tic douloureux and hemifacial spasm). Clin Neurosurg 1981; 28: 445-56.
  • McKenzie KG. Intracranial division of the vestibular portion of the auditory nerve for Meniere’s disease. Can Med Assoc J 1936; 34: 369-81.
  • Gardner WJ, Miklos MV. Response of trigeminal neuralgia to decompression of sensory root: discussion of cause of trigeminal neuralgia. JAMA 1959; 170: 1773-6.
  • Ehni G, Woltman HW. Hemifacial Spasm: Review of one hundred and siz cases. Arch Neur Psych 1945; 53: 205-11.
  • Janetta PJ. Neurovascular cross-compression in patients with hyperactive dysfunction of the eighth cranial nerve. Surg Forum 1975; 26: 467-9.
  • Schwaber MK, Hall W. Cochleovestibular nerve compression syndrome: clinical features and audiovestibular test findings. Laryngoscope 1992; 102: 1020-9.
  • Reisser C, Schuknecht HF. The anterior inferior cerebellar artery in the internal auditory canal. Laryngoscope 1991; 101: 761-6.
  • Markowski J, Gierek T, Kluczewska E, Witkowska M. Assessment of vestibulocochlear organ function in patients meeting radiologic criteria of vascular compression syndrome of vestibulocochlear nerve--diagnosis of disabling positional vertigo. Med Sci Monit 2011; 17: CR169-73.
  • Moller AR.Vascular compression of cranial nerves. II. Pathophysiology. Neurol Res 1999; 21: 439–43.
  • Makins AE, Nikolopoulos TP, Ludman C, O’Donoghue GM. Is there a correlation between vascular loops and unilateral auditory symptoms? Laryngoscope 1988; 108: 1739–42.
  • Brandt T, Dieterich M. VIII nerve vascular compression syndrome: vestibular paroxysmia. Baillieres Clin Neurol 1994; 3: 565–75.
  • Moosa S, Fezeu F, Kesser BW, Ramesh A, Sheehan JP. Sudden unilateral hearing loss and vascular loop in the internal auditory canal: case report and review of literature. J Radiosurg SBRT 2015; 3: 247-55.
  • Gorrie A, Warren 3rd FM, De la Garza AN, Shelton C, Wiggins 3rd RH. 2010. Is there a correlation between vascular loops in the cerebellopontine angle and unexplained unilateral hearing loss? Otology & Neurotology 2010; 31: 48-52
  • Yamakawa H, Hattori T, Tanigawara T, Sahashi Y, Ohkuma A. Intracanalicular aneurysm at the meatal loop of the distal anterior inferior cerebellar artery: a case report and review of the literature. Surg Neurol 2004; 61: 82-8.
  • Applebaum EL, Valvassori GE. 1984. Auditory and vestibular system findings in patients with vascular loops in the internal auditory canal. Annals of Otology, Rhinology and Laryngology: Supplement 1984; 112: 63-70.
  • Erdogan N, Altay C, Akay E, et al. MRI assesment of internal acoustic canal variations using 3D-FIESTA sequences. Eur Arch Otorhinolaryngol 2013; 270: 469–75.
  • Kawashima M, Rhoton AL, Tanriover N, Ulm AJ, Yasuda A, Fujii K. Microsurgical anatomy of cerebral revascularization. Part II: Posterior circulation. Jf Neurosurg 2005; 102: 132–47.
  • Fomkina OA, Nikolenko VN, Chernyshkova EV. Morphology and biomechanical properties of cerebellar arteries in adults. RusOMJ 2016; 5: e0205.
  • Kim HN, Kim YH, Park IY, Kim GR, Chung IH. Variability of the surgical anatomy of the neurovascular complex of the cerebellopontine angle. Annals of Otology, Rhinology and Laryngology 1990; 99: 288-96 .
  • Lee H, Cho YW. Auditory disturbance as a prodrome of anterior inferior cerebellar artery infarction. J Neurol Neurosurg Psychiatry 2003; 74: 1644-8.
  • Atkinson WJ The anterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry 1949; 12: 137–51.
  • Kim SH, Ju YR, Choi JE, Jung JY, Kim SY, Lee MY. Anatomical location of AICA loop in CPA as a prognos- tic factor for ISSNHL. PeerJ 2019; 7: e6582.
  • Sunderland S. The arterial relations of the internal auditorymeatus. Brain 1945; 68: 23-7.
  • Mazzoni A, Hansen CC. Surgical anatomy of the arteries of the internal auditory canal. Arch Otolaryngol Head Neck Surg 1970; 91: 128-35.
  • Oaknine GE. The arterial loops of the pontocerebellar angle. Adu Otorhinolaryngol 1982; 28: 121-38.
  • Akgun V, Battal B, Bozkurt Y et al. Normal anatomical features and variations of the vertebrobasilar circulation and its branches: an analysis with 64-detector row CT and 3 T MR angiographies. Sci World J 2013; 29: 620162.
  • Fkuda H, Ishikawa, Okumura R. Demonstration of neurovascular compression in trigeminal neuralgia and hemifacial spasm with magnetic resonance imaging: comparison with surgical findings in 60 consecutive cases. Surg Neurol 2003; 59: 93–100.
  • Gultekin S, Celik H, Akpek S, Oner Y, Gumus T, Tokgoz N Am J Neuroradiol 2008; 29: 1746-9.
  • Sirikci A, Beyazıt Y, Ozer E, et al. Magnetic resonance imaging based classification of anatomic relationship between the cochleovestibular nerve and anterior inferior cerebellar artery in patients with nonspecific neuro-otologic symptoms. Surg Radiol Anat 2005; 27: 531–5.
  • Grocoske FLB, Mendes RCCG, Vosguerau R, Mocellin M, de Oliveira MTCR, Koerner HN. Neurotology findings in patients with diagnosis of vascular loop of cranial nerves VIII in magnetic resonance imaging. Arq Int Otorrinolaringol 2011; 15: 418-25.

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

Year 2021, , 124 - 130, 21.12.2021
https://doi.org/10.47582/jompac.1027717

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.

Project Number

YOK

References

  • Nowé V, De Ridder D, Van de Heyning PH, et al. Does the location of a vascular loop in the cerebellopontine angle explain pulsatile and non-pulsatile tinnitus? Eur Radiol 2004; 14: 2282-9.
  • Aksoy S, Fırat Y, Alpar R. The tinnitus handicap inventory: A study of validity and reliability. Int Tinnitus J 2007; 13: 94-8.
  • Demir E, Beyazal Celiker F, Celiker M, Aydin Balaban G, Dursun E. The effect of vascular loop in the tinnitus severity. Akd Med J 2020; 2: 249-55.
  • Wu D, Zheng Y, Chen Z, Ma Y, Lu T. Further validation of the Chinese (Mandarin) Tinnitus Handicap Inventory: comparison between patient-reported and clinicalinterviewed outcomes. Int J Audiol 2018; 57: 440-8.
  • Formánek M, Migaľová P, Krulová P, et al. Combined transcranial magnetic stimulation in the treatment of chronic tinnitus. Ann Clin Transl Neurol 2018; 5: 857-64.
  • Zidan, M.A., Almansor, N. Presence of vascular loop in patients with audio-vestibular symptoms: is it a significant finding? Evaluation with 3-tesla MRI 3D constructive interference steady state (CISS) sequence. Egypt J Radiol Nucl Med 2020; 51, 114.
  • McDermott AL, Dutt SN, Irving RM, Pahor AL, Chavda SV. Anterior inferior cerebellar artery syndrome: fact or fiction. Clin Otolaryngol Allied Sci 2003; 28: 75-80.
  • Ryu H, Yamamoto S, Sugiyama K, et al. Neurovascular compression syndrome of the eight cranial nerve: what are the most reliable diagnostic signs? Acta Neurochir (Wien) 1998; 140: 1279–86.
  • Ryu H, Yamamoto S, Sugiyama K, et al. Can the site of compression explain the symptoms? Acta Neurochir (Wien) 1999; 141: 495–301.
  • De Ridder D, De Ridder L, Nowe´ V, et al. Pulsatile tinnitus and the intrameatal vascular loop: why do we not hear our carotids? Neurosurgery 2005; 57: 1213–17.
  • Lee H. Neuro-otological aspects of cerebellar stroke syndrome. J Clin Neurol 2009; 5: 65-73.
  • Schultze, F. Linksseitiger facialiskrampf in folge eines aneurysma der arteria vertebralis sinistra. Archive Pathol Anat 1875; 65: 385–91.
  • Dandy WE. Concerning the cause o f trigeminal neuralgia. Am J Surg 1934; 24: 447-55.
  • Jannetta PJ. Cranial nerve vascular compression syndromes (other than tic douloureux and hemifacial spasm). Clin Neurosurg 1981; 28: 445-56.
  • McKenzie KG. Intracranial division of the vestibular portion of the auditory nerve for Meniere’s disease. Can Med Assoc J 1936; 34: 369-81.
  • Gardner WJ, Miklos MV. Response of trigeminal neuralgia to decompression of sensory root: discussion of cause of trigeminal neuralgia. JAMA 1959; 170: 1773-6.
  • Ehni G, Woltman HW. Hemifacial Spasm: Review of one hundred and siz cases. Arch Neur Psych 1945; 53: 205-11.
  • Janetta PJ. Neurovascular cross-compression in patients with hyperactive dysfunction of the eighth cranial nerve. Surg Forum 1975; 26: 467-9.
  • Schwaber MK, Hall W. Cochleovestibular nerve compression syndrome: clinical features and audiovestibular test findings. Laryngoscope 1992; 102: 1020-9.
  • Reisser C, Schuknecht HF. The anterior inferior cerebellar artery in the internal auditory canal. Laryngoscope 1991; 101: 761-6.
  • Markowski J, Gierek T, Kluczewska E, Witkowska M. Assessment of vestibulocochlear organ function in patients meeting radiologic criteria of vascular compression syndrome of vestibulocochlear nerve--diagnosis of disabling positional vertigo. Med Sci Monit 2011; 17: CR169-73.
  • Moller AR.Vascular compression of cranial nerves. II. Pathophysiology. Neurol Res 1999; 21: 439–43.
  • Makins AE, Nikolopoulos TP, Ludman C, O’Donoghue GM. Is there a correlation between vascular loops and unilateral auditory symptoms? Laryngoscope 1988; 108: 1739–42.
  • Brandt T, Dieterich M. VIII nerve vascular compression syndrome: vestibular paroxysmia. Baillieres Clin Neurol 1994; 3: 565–75.
  • Moosa S, Fezeu F, Kesser BW, Ramesh A, Sheehan JP. Sudden unilateral hearing loss and vascular loop in the internal auditory canal: case report and review of literature. J Radiosurg SBRT 2015; 3: 247-55.
  • Gorrie A, Warren 3rd FM, De la Garza AN, Shelton C, Wiggins 3rd RH. 2010. Is there a correlation between vascular loops in the cerebellopontine angle and unexplained unilateral hearing loss? Otology & Neurotology 2010; 31: 48-52
  • Yamakawa H, Hattori T, Tanigawara T, Sahashi Y, Ohkuma A. Intracanalicular aneurysm at the meatal loop of the distal anterior inferior cerebellar artery: a case report and review of the literature. Surg Neurol 2004; 61: 82-8.
  • Applebaum EL, Valvassori GE. 1984. Auditory and vestibular system findings in patients with vascular loops in the internal auditory canal. Annals of Otology, Rhinology and Laryngology: Supplement 1984; 112: 63-70.
  • Erdogan N, Altay C, Akay E, et al. MRI assesment of internal acoustic canal variations using 3D-FIESTA sequences. Eur Arch Otorhinolaryngol 2013; 270: 469–75.
  • Kawashima M, Rhoton AL, Tanriover N, Ulm AJ, Yasuda A, Fujii K. Microsurgical anatomy of cerebral revascularization. Part II: Posterior circulation. Jf Neurosurg 2005; 102: 132–47.
  • Fomkina OA, Nikolenko VN, Chernyshkova EV. Morphology and biomechanical properties of cerebellar arteries in adults. RusOMJ 2016; 5: e0205.
  • Kim HN, Kim YH, Park IY, Kim GR, Chung IH. Variability of the surgical anatomy of the neurovascular complex of the cerebellopontine angle. Annals of Otology, Rhinology and Laryngology 1990; 99: 288-96 .
  • Lee H, Cho YW. Auditory disturbance as a prodrome of anterior inferior cerebellar artery infarction. J Neurol Neurosurg Psychiatry 2003; 74: 1644-8.
  • Atkinson WJ The anterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry 1949; 12: 137–51.
  • Kim SH, Ju YR, Choi JE, Jung JY, Kim SY, Lee MY. Anatomical location of AICA loop in CPA as a prognos- tic factor for ISSNHL. PeerJ 2019; 7: e6582.
  • Sunderland S. The arterial relations of the internal auditorymeatus. Brain 1945; 68: 23-7.
  • Mazzoni A, Hansen CC. Surgical anatomy of the arteries of the internal auditory canal. Arch Otolaryngol Head Neck Surg 1970; 91: 128-35.
  • Oaknine GE. The arterial loops of the pontocerebellar angle. Adu Otorhinolaryngol 1982; 28: 121-38.
  • Akgun V, Battal B, Bozkurt Y et al. Normal anatomical features and variations of the vertebrobasilar circulation and its branches: an analysis with 64-detector row CT and 3 T MR angiographies. Sci World J 2013; 29: 620162.
  • Fkuda H, Ishikawa, Okumura R. Demonstration of neurovascular compression in trigeminal neuralgia and hemifacial spasm with magnetic resonance imaging: comparison with surgical findings in 60 consecutive cases. Surg Neurol 2003; 59: 93–100.
  • Gultekin S, Celik H, Akpek S, Oner Y, Gumus T, Tokgoz N Am J Neuroradiol 2008; 29: 1746-9.
  • Sirikci A, Beyazıt Y, Ozer E, et al. Magnetic resonance imaging based classification of anatomic relationship between the cochleovestibular nerve and anterior inferior cerebellar artery in patients with nonspecific neuro-otologic symptoms. Surg Radiol Anat 2005; 27: 531–5.
  • Grocoske FLB, Mendes RCCG, Vosguerau R, Mocellin M, de Oliveira MTCR, Koerner HN. Neurotology findings in patients with diagnosis of vascular loop of cranial nerves VIII in magnetic resonance imaging. Arq Int Otorrinolaringol 2011; 15: 418-25.
There are 43 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Fatih Çankal 0000-0003-1066-353X

Project Number YOK
Publication Date December 21, 2021
Published in Issue Year 2021

Cite

AMA Çankal F. 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. J Med Palliat Care / JOMPAC / Jompac. December 2021;2(4):124-130. doi:10.47582/jompac.1027717

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