Secondary Benefits of Microsurgical Intervention on the Vertebral Artery (V1 Segment) for Refractory Vertebrobasilar Insufficiency: Alleviation of Parkinsonism-like Symptoms.

OBJECTIVE: To investigate the outcomes of micro-neurosurgical interventions on V1 segment of vertebral artery (VA) in patients with refractory vertebrobasilar insufficiency (VBI) due to dolicoarteriopathy and external compressions and to assess the secondary benefits of Parkinsonism-like symptoms.

METHODS: Retrospective analysis encompassed 101 patients treated for VA dolicoarteriopathy or compression-related refractory VBI from 2016-2023. Of these, 16 patients exhibited drug-resistant Parkinsonism-like symptoms. The diagnostic evaluation included cerebral CT/MR angiography or DSA and brain CT or MR perfusion studies, corroborated by preoperative and 6- and 12-month postoperative MDS-UPDRS Part 3 assessments. Data was analyzed through Turkey's 'E-nabız' system, employing Stata16 for statistical scrutiny.

RESULTS: A significant reduction in MDS-UPDRS scores was observed (preoperative: 26.75 ± 10.91; 6 months: 23.09 ± 9.24; 12 months: 22.5 ± 8.73; P<0.001). Postoperative follow-up denoted that 43.7% of patients ceased medication, and 50% reduced antiparkinsonian drugs. The micro-neurosurgical approach resulted in complete remission of VBI-related symptoms in 84.6% of patients, with the rest showing partial or marked improvement. At six months post-operation, perfusion studies revealed posterior border zone or cerebellar perfusion enhancements in 81% (13 out of 16) of patients, with full symptom resolution, while the remaining 19% (3 out of 16) showed partial perfusion and clinical improvements, particularly in regions supplied by the posterior cerebellar artery (PCA) or posterior inferior cerebellar artery (PICA). The absence of operative mortality and minimal transient morbidities underscored the procedure's safety.

CONCLUSION: Microneurosurgery for VA anomalies in refractory VBI patients, particularly those with concomitant parkinsonian-like syndromes, has demonstrated potential in symptom remission and medication reduction.