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

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

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

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