Treatment of vertebrobasilar insufficiency in a neurosurgical hospital

This article presents the treatment outcomes for 100 patients with vertebrobasilar insufficiency (VBI) associated with tortuosity of the V1 segment of the VA, who were divided into 2 groups: Surgical (n = 50) and conservative treatment (n = 50). Together with conventional diagnostic methods used to clarify the tactics of surgical treatment (Doppler ultrasonography, contrast-enhanced multi-spiral computed tomography) a proposed method to determine VA reactivity and impaired blood flow in the VBS is a key method for the prediction of clinical outcomes following surgery on the VBS arteries. Cerebral angiography is recommended in all patients before surgery on the VBS arteries, in order to determine the state of the intracranial part of the vertebral and main arteries, as outflow paths, and to determine collateral compensation in the VBS. Further use of reconstructive techniques on the V1 segment of the VA show better distant clinical outcomes. Tortuosity resection in the V1 segment of the VA is most effective in the immediate postoperative period and is used in patients with multiple lesions of the arteries as the first stage to increase the resistance of the brain to ischemia in subsequent reconstructive surgery. The use of conservative treatment in patients with concomitant lesions of the VBS is possible. Immediate outcomes are satisfactory. © 2021 Krause und Pachernegg GmbH. All rights reserved.