Microvascular Decompression for Neurovascular Compression Syndromes Secondary to Vertebrobasilar Dolichoectasia: A Single-Center Retrospective Analysis

Mauro Alberto Segura-Lozano¹Mario Alexis Del Real Gallegos²Mendoza Lemus¹Bernardo Tenorio-González¹Yael Rodrigo Torres Torres¹Alejandro Gonzalez-Silva³Octavio Carranza-Rentería¹Angel Gabriel Parra Galvan¹Aarón Giovanni Munguía-Rodríguez^1*

• ¹Neurología Segura Medical Center, Hospital Ángeles Morelia, Michoacán, Mexico
• ²Hospital Ángeles Morelia, Michoacán, Mexico
• ³asistente.medico@neurologiasegura.net, Hospital Ángeles Morelia, Michoacán, Mexico

Background: Vertebrobasilar dolichoectasia (VBD) is a rare cause of neurovascular compression syndromes (NVCS), including trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN). Microvascular decompression (MVD) is the primary surgical treatment; however, VBD-related cases are technically challenging and carry a higher risk of complications. Objective: To analyze the clinical characteristics, surgical findings, outcomes, and complications of patients with NVCS secondary to VBD treated with MVD. Methods: A retrospective single-center study was conducted on 68 patients who underwent MVD for VBD-associated NVCS between January 2014 and December 2024. Clinical, imaging, intraoperative, and postoperative data were collected and analyzed. Interposition and transposition techniques were employed according to intraoperative findings. Results: Among the 68 patients, TN was present in 49 cases (72.1%), HFS in 7 (10.3%), GPN in 4 (5.9%), and combined neuropathies in 8 (11.8%). Complete symptom relief was achieved in 92.5% of TN/GPN cases and 55.6% of HFS. During follow-up (mean = 27.3 months), TN recurred in 5.3% and HFS in 11.1%. Transient complications occurred in 67.6%, of patients, while persistent deficits were reported in 36.8%. Comparative analysis showed that patients with VBD were older (p < 0.001), predominantly male (p < 0.001), and had a higher prevalence of hypertension (p < 0.001) or diabetes (p = 0.014) compared to those with classical NVCS. Conclusions: MVD remains a safe and effective treatment for NVCS caused by VBD. However, the technical complexity of these cases demands meticulous surgical planning and long-term follow-up. Both interposition and transposition techniques yielded favorable outcomes.