Vertebrobasilar insufficiency

Part 1: Microsurgical treatment of extracranial vertebrobasilar disease

Robert F. SpetzlerDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, and Dent Neurologic Institute of Millard Fillmore Hospital and Department of Neurosurgery, State University of New York, Buffalo, New York

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Mark N. HadleyDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, and Dent Neurologic Institute of Millard Fillmore Hospital and Department of Neurosurgery, State University of New York, Buffalo, New York

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Neil A. MartinDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, and Dent Neurologic Institute of Millard Fillmore Hospital and Department of Neurosurgery, State University of New York, Buffalo, New York

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Leo N. HopkinsDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, and Dent Neurologic Institute of Millard Fillmore Hospital and Department of Neurosurgery, State University of New York, Buffalo, New York

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L. Philip CarterDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, and Dent Neurologic Institute of Millard Fillmore Hospital and Department of Neurosurgery, State University of New York, Buffalo, New York

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James BudnyDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, and Dent Neurologic Institute of Millard Fillmore Hospital and Department of Neurosurgery, State University of New York, Buffalo, New York

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Page Range:
648–661
Volume/Issue:
Volume 66: Issue 5
DOI link:
https://doi.org/10.3171/jns.1987.66.5.0648
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✓ Extracranial vertebrobasilar artery thrombo-occlusive disease may cause repetitive transient ischemic episodes and, less frequently, brain-stem or cerebellar infarction. This report describes 40 patients who experienced repetitive vertebrobasilar ischemic symptoms despite maximal medical therapy. The natural history, pathogenesis, and treatment options for each causative lesion are reviewed. The operative approaches to symptomatic disease of the proximal vertebral arteries, arterial compression by cervical osteophytes, traumatic lesions of the vertebral arteries, and thrombo-occlusive pathology of the distal extracranial vertebral arteries are outlined. Specific anesthetic and surgical techniques that have proved successful while achieving zero operative mortality and low perioperative morbidity rates are reported.

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Contributor Notes

Address reprint requests to: Robert F. Spetzler, M.D., Editorial Office, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013.

Address for Drs. Hopkins and Budny: Dent Neurologic Institute of Millard Fillmore Hospital and Department of Neurosurgery, State University of New York, Buffalo, New York.

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