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Complementary advantages of microsurgical treatment for vertebral artery dolicoarteriopathies: Mitigating symptoms of restless leg syndrome in refractory vertebrobasilar insufficiency

Yıl 2024, Cilt: 37 Sayı: 2, 224 - 230, 31.05.2024
https://doi.org/10.5472/marumj.1479815

Öz

Objective: This retrospective study examines the impact of microsurgical treatment on vertebral artery (VA) dolicoarteriopathies and
associated restless leg syndrome (RLS) in patients with refractory vertebrobasilar insufficiency (VBI).
Patients and Methods: We analyzed 78 patients with grade 2 and 3 kinks, and found out that the targeted microsurgical interventions,
primarily designed to address VBI, improved secondary RLS symptoms in 12 patients. Procedures included arteriolysis and, depending
on severity, grafting. Statistical analysis was conducted using Stata 16 (StataCorp LP, Texas, USA).
Results: In twelve patients aged 55 to 72 years with refractory VBI and drug-resistant RLS, micro-neurosurgical correction of V1
segment dolicoarteriopathy, abnormal elongation and kinks in the artery, demonstrated promising outcomes. Postoperatively, 83.33%
(10 patients) reported complete resolution of RLS symptoms, and 16.66% (2 patients) experienced partial symptom relief (p<0.05).
Overall, 86.8% of various VBI-related symptoms were significantly improved or resolved (p<0.05). The microsurgical technique,
avoiding traditional flow-arresting procedures, proved to be highly effective in this preliminary study with no mortality and minimal
temporary complications, underscoring its potential treatment avenue for such complex neurovascular conditions.
Conclusion: This study illuminates the relationship between VBI and RLS, proposing a potential vascular etiology for RLS, and
highlights the need for a broader diagnostic approach for patients with refractory VBI.

Kaynakça

  • Ekşi MŞ, Toktaş ZO, Yılmaz B, et al. Vertebral artery loops in surgical perspective. Eur Spine J 2016;25:4171-80. doi: 10.1007/s00586.016.4691-1.
  • Omotoso BR, Harrichandparsad R, Moodley IG, Satyapal KS, Lazarus L. An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population. Surg Radiol Anat 2021;43:929-41. doi: 10.1007/ s00276.021.02712-x.
  • Metz H, Bannister RG, Murray-Leslie RM, Bull JWD, Marshall J. Kinking of the internal carotid artery. The Lancet 1961;277:424-6. doi: 10.1016/S0140-6736(61)90004-6.
  • Wang J, Lu J, Qi P, et al. Association between kinking of the cervical carotid or vertebral artery and ischemic stroke/tia. Front Neurol 2022;13. doi: 10.3389/fneur.2022.100.8328.
  • Cekic E, Surme MB, Akbulut F, Ozturk R, Ustun ME. Secondary benefits of microsurgical intervention on the vertebral artery (V1 Segment) for refractory vertebrobasilar insufficiency: alleviation of Parkinsonism-like symptoms. World Neurosurg 2024. doi: 0.1016/j.wneu.2024.04.125.
  • Yenigun A, Ustun ME, Tugrul S, Dogan R, Ozturan O. Classification of vertebral artery loop formation and association with cervicogenic dizziness. J Laryngol Otol 2016;130:1115-9. doi: 10.1017/S002.221.5116009117.
  • Paksoy Y, Levendoglu FD, Ögün CÖ, Üstün ME, Ögün TC. Vertebral artery loop formation: a frequent cause of cervicobrachial pain. Spine (Phila Pa 1976) 2003;28:1183-8. doi: 10.1097/01.BRS.000.006.7275.08517.58.
  • Rennert RC, Steinberg JA, Strickland BA, et al. Extracranialto- intracranial bypass for refractory vertebrobasilar insufficiency. World Neurosurg 2019;126:552-9. doi: 10.1016/j. wneu.2019.03.184.
  • Starke RM, Chwajol M, Lefton D, Sen C, Berenstein A, Langer DJ. Occipital artery-to-posterior inferior cerebellar artery bypass for treatment of bilateral vertebral artery occlusion. Neurosurgery 2009;64:E779-81. doi: 10.1227/01. NEU.000.033.9351.65061.D6.
  • Lu X, Ma Y, Yang B, Gao P, Wang Y, Jiao L. Hybrid technique for the treatment of refractory vertebrobasilar insufficiencies. World Neurosurg 2017;107:1051.e13-1051.e17. doi: 10.1016/j. wneu.2017.08.081.
  • Boulos MI, Wan A, Black SE, Lim AS, Swartz RH, Murray BJ. Restless legs syndrome after high-risk tia and minor stroke: association with reduced quality of life. Sleep Med 2017;37:135-40. doi: 10.1016/j.sleep.2017.05.020.
  • Liu Z, Guan R, Pan L. Exploration of restless legs syndrome under the new concept: a review. Medicine 2022;101:e32324. doi: 10.1097/MD.000.000.0000032324.
  • Wang X-X, Feng Y, Tan E-K, Ondo WG, Wu Y-C. Strokerelated restless legs syndrome: epidemiology, clinical characteristics, and pathophysiology. Sleep Med 2022;90:238- 48. doi: 10.1016/j.sleep.2022.02.001.
  • Kalampokini S, Poyiadjis S, Vavougios GD, et al. Restless legs syndrome due to brainstem stroke: a systematic review. Acta Neurol Scand 2022;146:440-7. doi: 10.1111/ane.13702.
  • Mogavero MP, Mezzapesa DM, Savarese M, DelRosso LM, Lanza G, Ferri R. Morphological analysis of the brain subcortical gray structures in restless legs syndrome. Sleep Med 2021;88:74-80. doi: 10.1016/j.sleep.2021.10.025.
  • Trenkwalder C, Allen R, Högl B, Paulus W, Winkelmann J. Restless legs syndrome associated with major diseases. Neurology 2016;86:1336-43. doi: 10.1212/ WNL.000.000.0000002542.
  • Ferini-Strambi L, Walters AS, Sica D. The relationship among restless legs syndrome (Willis–Ekbom Disease), hypertension, cardiovascular disease, and cerebrovascular disease. J Neurol 2014;261:1051-68. doi: 10.1007/s00415.013.7065-1.
  • Ferri R, Cosentino FII, Moussouttas M, Lanuzza B, Aricò D, Bagai K, et al. Silent cerebral small vessel disease in restless legs syndrome. Sleep 2016;39:1371-7. doi: 10.5665/sleep.5966.
  • Locke JA, Macnab A, Garg S, McKeown M, Stothers L. Characterizing the cortical pathways underlying visual trigger induced urinary urgency incontinence by functional MRI. Neurourol Urodyn 2022;41:48-53. doi: 10.1002/nau.24824.
  • Allen RP, Picchietti DL, Garcia-Borreguero D, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated international restless legs syndrome study group (IRLSSG) consensus criteria – history, rationale, description, and significance. Sleep Med 2014;15:860-73. doi: 10.1016/j. sleep.2014.03.025.
  • Latz D, Grassmann J, Schiffner E, et al. Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report. J Med Case Rep 2017;11:69. doi: 10.1186/s13256.017.1240-4.
  • Sadri L, Myers RL, Paterson C, Lam Q-D, Pineda DM. Popliteal artery entrapment syndrome treated by a posterior approach in a 15-year-old athlete. J Vasc Surg Cases Innov and Tech 2022;8:248-50. doi: 10.1016/j.jvscit.2022.03.009.
  • Teijink SBJ, Goeteyn J, Pesser N, van Nuenen BFL, Thompson RW, Teijink JAW. Surgical approaches for thoracic outlet decompression in the treatment of thoracic outlet syndrome. J Thorac Dis 2023;15:7088-99. doi: 10.21037/jtd-23-546.
  • Ruppert E, Kilic-Huck U, Wolff V, et al. Brainstem stroke-related restless legs syndrome: frequency and anatomical considerations. Eur Neurol 2015;73:113-8. doi: 10.1159/000366416.
  • Shiina T, Suzuki K, Okamura M, Matsubara T, Hirata K. Restless legs syndrome and its variants in acute ischemic stroke. Acta Neurol Scand 2019;139:260-8. doi: 10.1111/ ane.13055.
  • Gupta A, Shukla G, Mohammed A, Goyal V, Behari M. Restless legs syndrome, a predictor of subcortical stroke: a prospective study in 346 stroke patients. Sleep Med 2017;29:61-7. doi: 10.1016/j.sleep.2015.05.025.
  • Boulos MI, Wan A, Black SE, Lim AS, Swartz RH, Murray BJ. Restless legs syndrome after high-risk tia and minor stroke: association with reduced quality of life. Sleep Med 2017;37:135-40. doi: 10.1016/j.sleep.2017.05.020.
  • Kalampokini S, Poyiadjis S, Vavougios GD, et al. Restless legs syndrome due to brainstem stroke: a systematic review. Acta Neurol Scand 2022;146:440-7. doi: 10.1111/ane.13702.
  • Cekic E, Pinar E, Pinar M, Dagcinar A. Deep learning-assisted segmentation and classification of brain tumor types on magnetic resonance and surgical microscope images. World Neurosurg 2023. doi: 10.1016/j.wneu.2023.11.073.
  • Cekic E, Ustun ME. Adventitia layer-focused microsurgical flow reconstruction for long-segment tubular stenosis of the cervical segment (C1) internal carotid artery: clinical valuable experience in 20 cases. Brain Sci 2024;14:289. doi: 10.3390/ brainsci14030289.
Yıl 2024, Cilt: 37 Sayı: 2, 224 - 230, 31.05.2024
https://doi.org/10.5472/marumj.1479815

Öz

Kaynakça

  • Ekşi MŞ, Toktaş ZO, Yılmaz B, et al. Vertebral artery loops in surgical perspective. Eur Spine J 2016;25:4171-80. doi: 10.1007/s00586.016.4691-1.
  • Omotoso BR, Harrichandparsad R, Moodley IG, Satyapal KS, Lazarus L. An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population. Surg Radiol Anat 2021;43:929-41. doi: 10.1007/ s00276.021.02712-x.
  • Metz H, Bannister RG, Murray-Leslie RM, Bull JWD, Marshall J. Kinking of the internal carotid artery. The Lancet 1961;277:424-6. doi: 10.1016/S0140-6736(61)90004-6.
  • Wang J, Lu J, Qi P, et al. Association between kinking of the cervical carotid or vertebral artery and ischemic stroke/tia. Front Neurol 2022;13. doi: 10.3389/fneur.2022.100.8328.
  • Cekic E, Surme MB, Akbulut F, Ozturk R, Ustun ME. Secondary benefits of microsurgical intervention on the vertebral artery (V1 Segment) for refractory vertebrobasilar insufficiency: alleviation of Parkinsonism-like symptoms. World Neurosurg 2024. doi: 0.1016/j.wneu.2024.04.125.
  • Yenigun A, Ustun ME, Tugrul S, Dogan R, Ozturan O. Classification of vertebral artery loop formation and association with cervicogenic dizziness. J Laryngol Otol 2016;130:1115-9. doi: 10.1017/S002.221.5116009117.
  • Paksoy Y, Levendoglu FD, Ögün CÖ, Üstün ME, Ögün TC. Vertebral artery loop formation: a frequent cause of cervicobrachial pain. Spine (Phila Pa 1976) 2003;28:1183-8. doi: 10.1097/01.BRS.000.006.7275.08517.58.
  • Rennert RC, Steinberg JA, Strickland BA, et al. Extracranialto- intracranial bypass for refractory vertebrobasilar insufficiency. World Neurosurg 2019;126:552-9. doi: 10.1016/j. wneu.2019.03.184.
  • Starke RM, Chwajol M, Lefton D, Sen C, Berenstein A, Langer DJ. Occipital artery-to-posterior inferior cerebellar artery bypass for treatment of bilateral vertebral artery occlusion. Neurosurgery 2009;64:E779-81. doi: 10.1227/01. NEU.000.033.9351.65061.D6.
  • Lu X, Ma Y, Yang B, Gao P, Wang Y, Jiao L. Hybrid technique for the treatment of refractory vertebrobasilar insufficiencies. World Neurosurg 2017;107:1051.e13-1051.e17. doi: 10.1016/j. wneu.2017.08.081.
  • Boulos MI, Wan A, Black SE, Lim AS, Swartz RH, Murray BJ. Restless legs syndrome after high-risk tia and minor stroke: association with reduced quality of life. Sleep Med 2017;37:135-40. doi: 10.1016/j.sleep.2017.05.020.
  • Liu Z, Guan R, Pan L. Exploration of restless legs syndrome under the new concept: a review. Medicine 2022;101:e32324. doi: 10.1097/MD.000.000.0000032324.
  • Wang X-X, Feng Y, Tan E-K, Ondo WG, Wu Y-C. Strokerelated restless legs syndrome: epidemiology, clinical characteristics, and pathophysiology. Sleep Med 2022;90:238- 48. doi: 10.1016/j.sleep.2022.02.001.
  • Kalampokini S, Poyiadjis S, Vavougios GD, et al. Restless legs syndrome due to brainstem stroke: a systematic review. Acta Neurol Scand 2022;146:440-7. doi: 10.1111/ane.13702.
  • Mogavero MP, Mezzapesa DM, Savarese M, DelRosso LM, Lanza G, Ferri R. Morphological analysis of the brain subcortical gray structures in restless legs syndrome. Sleep Med 2021;88:74-80. doi: 10.1016/j.sleep.2021.10.025.
  • Trenkwalder C, Allen R, Högl B, Paulus W, Winkelmann J. Restless legs syndrome associated with major diseases. Neurology 2016;86:1336-43. doi: 10.1212/ WNL.000.000.0000002542.
  • Ferini-Strambi L, Walters AS, Sica D. The relationship among restless legs syndrome (Willis–Ekbom Disease), hypertension, cardiovascular disease, and cerebrovascular disease. J Neurol 2014;261:1051-68. doi: 10.1007/s00415.013.7065-1.
  • Ferri R, Cosentino FII, Moussouttas M, Lanuzza B, Aricò D, Bagai K, et al. Silent cerebral small vessel disease in restless legs syndrome. Sleep 2016;39:1371-7. doi: 10.5665/sleep.5966.
  • Locke JA, Macnab A, Garg S, McKeown M, Stothers L. Characterizing the cortical pathways underlying visual trigger induced urinary urgency incontinence by functional MRI. Neurourol Urodyn 2022;41:48-53. doi: 10.1002/nau.24824.
  • Allen RP, Picchietti DL, Garcia-Borreguero D, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated international restless legs syndrome study group (IRLSSG) consensus criteria – history, rationale, description, and significance. Sleep Med 2014;15:860-73. doi: 10.1016/j. sleep.2014.03.025.
  • Latz D, Grassmann J, Schiffner E, et al. Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report. J Med Case Rep 2017;11:69. doi: 10.1186/s13256.017.1240-4.
  • Sadri L, Myers RL, Paterson C, Lam Q-D, Pineda DM. Popliteal artery entrapment syndrome treated by a posterior approach in a 15-year-old athlete. J Vasc Surg Cases Innov and Tech 2022;8:248-50. doi: 10.1016/j.jvscit.2022.03.009.
  • Teijink SBJ, Goeteyn J, Pesser N, van Nuenen BFL, Thompson RW, Teijink JAW. Surgical approaches for thoracic outlet decompression in the treatment of thoracic outlet syndrome. J Thorac Dis 2023;15:7088-99. doi: 10.21037/jtd-23-546.
  • Ruppert E, Kilic-Huck U, Wolff V, et al. Brainstem stroke-related restless legs syndrome: frequency and anatomical considerations. Eur Neurol 2015;73:113-8. doi: 10.1159/000366416.
  • Shiina T, Suzuki K, Okamura M, Matsubara T, Hirata K. Restless legs syndrome and its variants in acute ischemic stroke. Acta Neurol Scand 2019;139:260-8. doi: 10.1111/ ane.13055.
  • Gupta A, Shukla G, Mohammed A, Goyal V, Behari M. Restless legs syndrome, a predictor of subcortical stroke: a prospective study in 346 stroke patients. Sleep Med 2017;29:61-7. doi: 10.1016/j.sleep.2015.05.025.
  • Boulos MI, Wan A, Black SE, Lim AS, Swartz RH, Murray BJ. Restless legs syndrome after high-risk tia and minor stroke: association with reduced quality of life. Sleep Med 2017;37:135-40. doi: 10.1016/j.sleep.2017.05.020.
  • Kalampokini S, Poyiadjis S, Vavougios GD, et al. Restless legs syndrome due to brainstem stroke: a systematic review. Acta Neurol Scand 2022;146:440-7. doi: 10.1111/ane.13702.
  • Cekic E, Pinar E, Pinar M, Dagcinar A. Deep learning-assisted segmentation and classification of brain tumor types on magnetic resonance and surgical microscope images. World Neurosurg 2023. doi: 10.1016/j.wneu.2023.11.073.
  • Cekic E, Ustun ME. Adventitia layer-focused microsurgical flow reconstruction for long-segment tubular stenosis of the cervical segment (C1) internal carotid artery: clinical valuable experience in 20 cases. Brain Sci 2024;14:289. doi: 10.3390/ brainsci14030289.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi (Diğer)
Bölüm Original Research
Yazarlar

Efecan Cekic 0000-0003-2203-5944

İskender Samet Daltaban 0000-0002-5786-2272

Mehmet Erkan Ustun Bu kişi benim 0000-0002-9704-1436

Yayımlanma Tarihi 31 Mayıs 2024
Gönderilme Tarihi 4 Mart 2024
Kabul Tarihi 26 Nisan 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 37 Sayı: 2

Kaynak Göster

APA Cekic, E., Daltaban, İ. S., & Ustun, M. E. (2024). Complementary advantages of microsurgical treatment for vertebral artery dolicoarteriopathies: Mitigating symptoms of restless leg syndrome in refractory vertebrobasilar insufficiency. Marmara Medical Journal, 37(2), 224-230. https://doi.org/10.5472/marumj.1479815
AMA Cekic E, Daltaban İS, Ustun ME. Complementary advantages of microsurgical treatment for vertebral artery dolicoarteriopathies: Mitigating symptoms of restless leg syndrome in refractory vertebrobasilar insufficiency. Marmara Med J. Mayıs 2024;37(2):224-230. doi:10.5472/marumj.1479815
Chicago Cekic, Efecan, İskender Samet Daltaban, ve Mehmet Erkan Ustun. “Complementary Advantages of Microsurgical Treatment for Vertebral Artery Dolicoarteriopathies: Mitigating Symptoms of Restless Leg Syndrome in Refractory Vertebrobasilar Insufficiency”. Marmara Medical Journal 37, sy. 2 (Mayıs 2024): 224-30. https://doi.org/10.5472/marumj.1479815.
EndNote Cekic E, Daltaban İS, Ustun ME (01 Mayıs 2024) Complementary advantages of microsurgical treatment for vertebral artery dolicoarteriopathies: Mitigating symptoms of restless leg syndrome in refractory vertebrobasilar insufficiency. Marmara Medical Journal 37 2 224–230.
IEEE E. Cekic, İ. S. Daltaban, ve M. E. Ustun, “Complementary advantages of microsurgical treatment for vertebral artery dolicoarteriopathies: Mitigating symptoms of restless leg syndrome in refractory vertebrobasilar insufficiency”, Marmara Med J, c. 37, sy. 2, ss. 224–230, 2024, doi: 10.5472/marumj.1479815.
ISNAD Cekic, Efecan vd. “Complementary Advantages of Microsurgical Treatment for Vertebral Artery Dolicoarteriopathies: Mitigating Symptoms of Restless Leg Syndrome in Refractory Vertebrobasilar Insufficiency”. Marmara Medical Journal 37/2 (Mayıs 2024), 224-230. https://doi.org/10.5472/marumj.1479815.
JAMA Cekic E, Daltaban İS, Ustun ME. Complementary advantages of microsurgical treatment for vertebral artery dolicoarteriopathies: Mitigating symptoms of restless leg syndrome in refractory vertebrobasilar insufficiency. Marmara Med J. 2024;37:224–230.
MLA Cekic, Efecan vd. “Complementary Advantages of Microsurgical Treatment for Vertebral Artery Dolicoarteriopathies: Mitigating Symptoms of Restless Leg Syndrome in Refractory Vertebrobasilar Insufficiency”. Marmara Medical Journal, c. 37, sy. 2, 2024, ss. 224-30, doi:10.5472/marumj.1479815.
Vancouver Cekic E, Daltaban İS, Ustun ME. Complementary advantages of microsurgical treatment for vertebral artery dolicoarteriopathies: Mitigating symptoms of restless leg syndrome in refractory vertebrobasilar insufficiency. Marmara Med J. 2024;37(2):224-30.