VASCULAR MALFORMATIONS IN THE BACKGROUND

OF COCHLEO-VESTIBULAR SYMPTOMS

Jarabin J, Nagy AL, Tanacs A, Czesznak A, Smehak Gy, Toth F, Rovo L, Jori J, Kiss JG.

1st International Symposium of Clinical and Applied AnatomySeptember 17-19, 2009, Novi Sad, Serbia

Neurovascular compression Neurovascular compression

Neuro-vascular conflict is a pathophysiologic phenomenon which is implicated in several

cranial neuropathies.

The most common are: - trigeminal neuralgia and hemifacial spasm.

Other phenomena are: - spasmodic torticolis

- glosopharyngeal neuralgia

- disabling positional vertigo

- neurogenic hypertension

- limited cases of tinnitus

- fluctuating low frequency sensorineural hearing loss

Current diagnostic approach comprises clinical and radiological evaluation. Along with

complete otoneurological examination, MRI scans are essential to diagnose the conflict.

This provides information about the presence of neuro-vascular conflict and involved

structures.

Investigation methodsInvestigation methods

Detailed anamnesisOtoneurological examinations

Basic ENT examinationsSpontaneous vestibular symptomsCaloric tests (Hallpike)

AudiometryPure tone audiometryEABRDPOAEImpedance audiometry

Radiological evaluation3D FIESTA Hi Res3DTOF HR

3D reconstructions with 3D Slicer Version 3.5 Alpha

Picture from Sobotta: Atlas Of Human Anatomy

Picture from János Vajda: Atlas anatomiae

Case hystory:Left sided low frequency hearing loss and pulsating tinnitus. Accompanied imbalance is also present.

Radiology:MRI scan+angiographyMRI scan+angiography revealed the underlying vascular malformation:the anterior inferior cerebellar artery’s (AICA) vascular kinking conflicts with the cochlear nerve

Case report: J.P. 52 year-old womanCase report: J.P. 52 year-old woman

Impedance audiometry:„A” type tympanogramLeft side missing stapedial rfx

DPOAE: missing OHC activity left sideEABR: within normal rangesOtoneurology: normal finding

SN hearing loss on the left side

3D reconstruction model3D reconstruction model

Case hystory:Left sided pulsating, low frequency tinnitus. Otherwise asymptomatic.

Radiology:MRI scan+angiographyMRI scan+angiography revealed the underlying vascular malformation: vascular loop conflicts the entry zone of the nerve VII-VIII.

Case report: I.F. 41 year-old womanCase report: I.F. 41 year-old woman

Impedance audiometry, DPOAE, EABR: within normal ranges

Otoneurology: no detectable vestibular lesion.

3D reconstruction model3D reconstruction model

SummarySummary

There are several cranial neuropathies including some vestibulo-cochlear symptoms which can be traced back to neuro-vascular conflicts. After a thorough case history taking and ENT examination the suspicion of the underlying compression can be revealed.

For the verification of our hypothesis High Resolution MRI+angiography scans are essential to be performed.

Using 3D Slicer Ver. 3.5 alpha software for reconstructing 3D models from the conventional MRI scans it is available also for clinicians to visualize the underlying vascular conflicts.

Microvascular decompression (MVD) is the treatment of choice, which can be facilitated by the 3D models.