NÖROTOLOJİK SEMPTOMLARI AÇIKLAMADA 7. - 8. SİNİR KOMPLEKSİ İÇİN VASKÜLER LOOP KOMPRESYONUNUN DEĞERLENDİRİLMESİ NE KADAR ETKİLİDİR ?

Year 2021, Volume: 22 Issue: 6, 445 - 449, 18.10.2021

Selçuk Yıldız Ayşe Özlem Balık

https://doi.org/10.18229/kocatepetip.790846

Abstract

AMAÇ: Bu çalışmanın amacı, vestibulokoklear sinirin (VCN) nörovasküler kompresyonunun radyolojik kanıtının tinnitus ve işitme kaybında patognomonik olup olmadığını manyetik rezonans görüntüleme (MRI) “3D Fast Imaging Employing Steady-State Acquisition (FIESTA)” sekansı kullanarak incelemektir.
GEREÇ VE YÖNTEM: Çalışma, sağ ve sol taraf dahil olmak üzere 85 hastada 170 temporal kemik değerlendirilmesi ile gerçekleştirildi. İnternal akustik kanal (İAK) orifisinde 1.5-Tesla MRI kullanılarak, anterior inferior serebellar arterin (AICA) sınıflandırılmış vasküler kompresyonları (Chavda sınıflandırması), AICA, superior serebellar arter (SCA) ve vertebral arter (VA) kompresyonu veya VCN'in distorsiyonu arasındaki anatomik ilişkinin noninvaziv değerlendirmesi yapıldı.
BULGULAR: Değerlendirilen 85 hastadan 36'sında (%42.4) vasküler loop izlenmedi. Chavda sınıflandırmasına göre 41'inde (%48.2) 1. derece vasküler loop, 7'sinde (%8.2) 2. derece vasküler loop ve 1'inde (%1.2) 3. derece vasküler loop saptandı. Ayrıca hastaların 6’sında (%7.1) VA kompresyonu ve 3’ünde (%3.5) SCA kompresyonu görüntülendi. Tinnitus şikayeti olan 16 (%32) hastada IAC distorsiyonu görüldü. Vasküler loop varlığı da sırasıyla tinnitus olmayan (%62.9) ve sağlıklı işiten (%51.8) olgularda yüksek insidans gösterdi. Hastaların nörotolojik semptomları için AICA loop tipleri, VA veya SCA ve IAC distorsiyonunun varlığı ve yokluğu arasında istatistiksel anlamlı farklılık saptanmadı (p > 0,05).
SONUÇ: Nörovasküler temas nadir bir bulgu değildir ve tinnitusla ilgili gözükmemektedir. Bununla birlikte 3D-FIESTA MRI kullanılması, VCN ve komşu vasküler varyasyonlar ile özellikle AICA varyasyonlarının ilişkisinin belirlenmesini iyi tanımlar ve mikrovasküler operasyonlar için vaka seçimine katkıda bulunur.

Keywords

3D-FIESTA, İşitme kaybı, Nörotolojik semptom, Tinnitus, Vasküler loop, Vasküler kompresyon sendromu, Vestibülokoklear sinir

HOW EFFECTIVE IS THE EVALUATION OF VASCULAR LOOP COMPRESSION FOR THE 7TH-8TH NERVE COMPLEX IN EXPLAINING NEURO - OTOLOGICAL SYMPTOMS ?

Abstract

OBJECTIVE: The goal of this research study was to investigate of whether the radiological proof of neurovascular compression of the vestibulocochlear nerve (VCN) was pathognomonic for hearing loss and tinnitus using “3D Fast Imaging Steady-State Acquisition (FIESTA)” magnetic resonance imaging (MRI) sequence.
MATERIAL AND METHODS: The research study was performed in 85 patients by evaluating 170 temporal bones, inclusive of both sides. The non-invasive assessment of the anatomical relationship between the classified vascular compression (Chavda classification) of the anterior inferior cerebellar artery (AICA) and the existence of AICA, superior cerebellar artery (SCA), vertebral artery (VA) compression or distortion of the VCN was applied by using 1.5-Tesla MRI at the internal acoustic canal (IAC).
RESULTS: Of the 85 participants examined, 42.4% (n = 36) presented no vascular loop (VL). 48.2% (n = 41) of the patients produced type 1 VL, 8.2% (n = 7) type 2 VL, and 1.2% (n = 1) type 3 VL accordingly to the Chavda classification. In addition, compressions of redundant VA and SCA were also observed in 7.1% (n = 6) and 3.5% (n = 3) of the patients respectively. Also, IAC distortion was found in 32% (n = 16) patients with tinnitus. The presence of vascular loops also showed a high incidence in patients with normal hearing (51.8%) and without tinnitus (62.9%), respectively. No statistically relevant variations were found between the existence and nonexistence of the VL of AICA forms, VA or SCA, and IAC distortion for the neurotological symptoms of patients (p > 0.05).
CONCLUSIONS: Neurovascular touch is not an uncommon finding. It doesn’t appear to be related to tinnitus. However, the use of 3D-FIESTA MRI well defines the relationship between VCN and adjacent vascular variations and especially AICA variations and contributes to case selection for microvascular operations.

Keywords

3D-FIESTA, Hearing loss, Neurotologic symptom, Vascular loop, Vascular compression syndrome, Vestibulocochlear nerve

References

• 1. Makins AE, Nikolopoulos TP, Ludman C, O’Donoghue GM. Is there a correlation between vascular loops and unilateral auditory symptoms? Laryngoscope. 1998; 108: 1739–42.
• 2. 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.
• 3. Wahlig JB, Kaufmann AM, Balzer J, Lovely TJ, Jannetta PJ. Intraoperative loss of auditory function relieved by microvascular decompression of the cochlear nerve. Can J Neurol Sci. 1999; 26: 44–7.
• 4. Kazawa N, Togashi K, Ito J. The anatomical classification of AICA/PICA branching and configurations in the cerebellopontine angle area on 3D-drive thin slice T2WI MRI. Clin Imaging. 2013; 37: 865–70.
• 5. Suzuki H, Maki H, Maeda M, Shimizu S, Trousset Y, Taki W. Visualization of the intracisternal angioarchitecture at the posterior fossa by use of image fusion. Neurosurgery. 2005; 56: 335–42.
• 6. Wuertenberger CJ, Rosahl SK. Vertigo and tinnitus caused by vascular compression of the vestibulocochlear nerve, not intracanalicular vestibular schwannoma: Review and case presentation. Skull Base. 2009; 19: 417–24.
• 7. Yap L, Pothula VB, Lesser T. Microvascular decompression of cochleovestibular nerve. Eur Arch Otorhinolaryngol. 2008;265:861–69.
• 8. Guevara N, Deveze A, Buza V, Laffont B, Magnan J. Microvascular decompression of cochlear nerve for tinnitus incapacity: pre-surgical data, surgical analyses, and long-term follow-up of 15 patients. Eur Arch Otorhinolaryngol. 2008; 265: 397–401.
• 9. Møller MB, Moller AR, Jannetta PJ, Jho HD, Sekhar LN. Microvascular decompression of the eighth nerve in patients with disabling positional vertigo: selection criteria and operative results in 207 patients. Acta Neurochir (Wien). 1993; 125: 75–82.
• 10. Herzog JA, Bailey S, Meyer J. Vascular loop of the internal auditory canal: a diagnostic dilemma. Am J Otol.1997; 18: 26–31.
• 11. McDermott AL, Dutt SN, Irving RM, Pahor AL, Chavda SV. Anterior inferior cerebellar artery syndrome: fact or fiction. Clin Otolaryngol. 2003; 28: 75–80.
• 12. 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.
• 13. Levy RA, Arts HA. Predicting neuroradiologic outcome in patients referred for audiovestibular dysfunction. AJNR Am J Neuroradiol. 1996; 17: 1717–24.
• 14. Jannetta PJ. Neurovascular cross-compression in patients with hyperactive dysfunction symptoms of the eighth cranial nerve. Surg Forum. 1975; 26: 467–9.
• 15. Jannetta PJ. Outcome after microvascular decompression for typical trigeminal neuralgia, hemifacial spasm, tinnitus, disabling positional vertigo, and glossopharyngeal neuralgia (honored guest lecture). Clin Neurosurg.1997; 44: 331–83.
• 16. Brackmann DE, Kesser BW, Day JD. Microvascular decompression of the vestibulocochlear nerve for disabling positional vertigo: the House Ear Clinic experience. Otol Neurotol. 2001; 22: 882–7.
• 17. Møller MB. Results of microvascular decompression of the eighth nerve as a treatment for disabling positional vertigo. Ann Otol Rhinol Laryngol. 1990; 99: 724–9.
• 18. Nowe´ V, De Ridder D, Van de Heyning PH, et al. Does the location of a vascular loop in the cerebellopontine angle explain pulsatile and nonpulsatile tinnitus? Eur Radiol. 2004; 14: 2282–9.
• 19. De Ridder D, De Ridder L, Nowe V, Thierens H, Van de Heyning P, Møller A. Pulsatile tinnitus, and the intrameatal vascular loop: why do we not hear our carotids? Neurosurgery. 2005; 57: 1213–7.
• 20. Gultekin S, Celik H, Akpek S, Oner Y, Gumus T, Tokgoz N. Vascular loops at the cerebellopontine angle: is there a correlation with tinnitus? AJNR Am J Neuroradiol. 2008; 29: 1746–9.
• 21. Clift JM, Wong RD, Carney GM, Stavinoha RC, Bovey KP. Radiographic analysis of cochlear nerve vascular compression. Ann Otol Rhinol Laryngol. 2009; 118: 356–61.
• 22. Erdogan N, Altay C, Akay E,et al. MRI assessment of internal acoustic canal variations using 3D-FIESTA sequences. Eur Arch Otorhinolaryngol. 2013; 270: 469–75.
• 23. Cicek ED. The Analysis of the Relationship Between Subjective Tinnitus and Vascular Loop, and Age and Gender Distribution: An MRI Study. EJMO. 2018; 2: 231–7.
• 24. Okamura T, Kurokawa Y, Ikeda N, et al. Microvascular decompression for cochlear symptoms. J Neurosurg. 2000; 93: 421–6.
• 25. Celiker FB, Dursun E, Celiker M, et al. Evaluation of vascular variations at cerebellopontine angle by 3D T2WI magnetic-resonance imaging in patients with vertigo. J Vestib Res. 2017; 27: 147-53.