Macrovascular decompression for medullary compression syndrome due to vertebral dolichoectatic arteries: A case report and literature review with 3D imaging support.

Background: Vascular compression of the medulla oblongata is a rare but serious condition most commonly caused by dolichoectatic vertebrobasilar arteries. This syndrome, sometimes referred to as vertebral artery compression syndrome, can result in severe and progressive neurological symptoms. Optimal diagnostic and therapeutic approaches remain challenging in complex cases of medullary compression caused by ectatic vertebral arteries. Case Description: We report a 55-year-old man with progressive neurological deficits secondary to bilateral vertebral artery compression of the medulla oblongata. He presented with tetraparesis, lower cranial nerve palsies, and significant gait disturbance. Preoperative magnetic resonance imaging confirmed bilateral dolichoectatic vertebral artery compression. Three-dimensional reconstructed images facilitated both diagnosis and surgical planning. Surgical macrovascular decompression was performed using sling transposition for the left vertebral artery and an interposition technique for the right vertebral artery. Postoperatively, the patient demonstrated significant neurological recovery, including complete resolution of cranial nerve deficits and marked improvement in motor function. Conclusion: This case demonstrates the effectiveness of combining vascular sling and interposition techniques for the treatment of complex vertebral artery compression of the medulla oblongata. Three-dimensional reconstructed images proved valuable for both diagnosis and treatment planning of this challenging condition.