Disabling Vertigo and Tinnitus Caused by Intrameatal Compression of the Anterior Inferior Cerebellar Artery on the Vestibulocochlear Nerve: A Case Report, Surgical Considerations, and Review of the Literature

Abstract

Microvascular compression of the vestibulocochlear nerve is known as a cause of tinnitus and vertigo in the literature, but our review of the literature shows that the compression is usually located in the cerebellopontine angle and not intrameatal.

We present a case of intrameatal compression of the anterior inferior cerebellar artery (AICA) on the vestibulocochlear nerve of a 40-year-old woman with symptoms of disabling vertigo and intermittent high-frequency tinnitus on the left side without any hearing loss for ∼ 4 years. Magnetic resonance imaging of the brain did not show any abnormality, but magnetic resonance angiography showed a left intrameatal AICA loop as a possible cause of the disabling symptoms. After the exclusion of other possible reasons for disabling vertigo, surgery was indicated. The intraoperative findings proved the radiologic findings. The large AICA loop was found extending into the internal auditory canal and compressing the vestibulocochlear nerve. The AICA loop was mobilized and separated from the vestibulocochlear nerve.

The patient's symptoms resolved immediately after surgery, and no symptoms were noted during 2 years of follow-up in our clinic. Her hearing was not affected by the surgery.

In addition to other common reasons, such as acoustic neuroma, disabling vertigo and tinnitus can occur from an intrameatal arterial loop compression of the vestibulocochlear nerve and may be treated successfully by drilling the internal acoustic meatus and separating the arterial conflict from the vestibulocochlear nerve.

Keywords

anterior inferior cerebellar artery - microvascular decompression - vertigo - internal auditory canal

• References

• 1 Sindou M, Leston J, Decullier E, Chapuis F. Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg 2007; 107 (6) 1144-1153
• 2 Miller LE, Miller VM. Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm: a systematic review. Br J Neurosurg 2012; 26 (4) 438-444
• 3 Noguchi Y, Ohgaki T, Tsunoda A, Komatsuzaki A, Muraoka H. Clinical study in vertiginuous patients suspected of having neurovascular compression syndrome of the eighth cranial nerve. [in Japanese]. Nippon Jibiinkoka Gakkai Kaiho 1997; 100 (5) 492-498
• 4 Møller MB, Møller AR, Jannetta PJ, Jho HD, Sekhar LN. Microvascular decompression of the eighth nerve in patients with disabling positional vertigo: selection criteria and operative results in 207 patients. Acta Neurochir (Wien) 1993; 125 (1–4) 75-82
• 5 Brackmann DE, Kesser BW, Day JD. Microvascular decompression of the vestibulocochlear nerve for disabling positional vertigo: the House Ear Clinic experience. Otol Neurotol 2001; 22 (6) 882-887
• 6 Okamura T, Kurokawa Y, Ikeda N , et al. Microvascular decompression for cochlear symptoms. J Neurosurg 2000; 93 (3) 421-426
• 7 Papanagiotou P, Grunwald IQ, Politi M, Struffert T, Ahlhelm F, Reith W. Vascular anomalies of the cerebellopontine angle. [in German]. Radiologe 2006; 46 (3) 216-222
• 8 Wuertenberger CJ, Rosahl SK. Vertigo and tinnitus caused by vascular compression of the vestibulocochlear nerve, not intracanalicular vestibular schwannoma: review and case presentation. Skull Base 2009; 19 (6) 417-424
• 9 Yasuoka S, Takakura K, Fukaya T. Case of tinnitus, vertigo, and a loss of caloric response due to neurovascular compression. [in Japanese]. No To Shinkei 1983; 35 (11) 1097-1101
• 10 De Ridder D, De Ridder L, Nowé V, Thierens H, Van de Heyning P, Møller A. Pulsatile tinnitus and the intrameatal vascular loop: why do we not hear our carotids?. Neurosurgery 2005; 57 (6) 1213-1217 ; discussion 1213–1217
• 11 Michel O, Jahns T, Joost-Enneking M, Neugebauer P, Streppel M, Stennert E. The Stennert antiphlogistic-rheologic infusion schema in treatment of cochleovestibular disorders. [in German]. HNO 2000; 48 (3) 182-188
• 12 Zhang K, Wang F, Zhang Y, Li M, Shi X. Anatomic investigation of the labyrinthine artery. [in Chinese]. Zhonghua Er Bi Yan Hou Ke Za Zhi 2002; 37 (2) 103-105
• 13 Lee H, Sohn SI, Jung DK , et al. Sudden deafness and anterior inferior cerebellar artery infarction. 2002; 33 (12) 2807-2812
• 14 Kim HN, Kim YH, Park IY, Kim GR, Chung IH. Variability of the surgical anatomy of the neurovascular complex of the cerebellopontine angle. Ann Otol Rhinol Laryngol 1990; 99 (4 Pt 1) 288-296
• 15 Martin RG, Grant JL, Peace D, Theiss C, Rhoton Jr AL. Microsurgical relationships of the anterior inferior cerebellar artery and the facial-vestibulocochlear nerve complex. Neurosurgery 1980; 6 (5) 483-507
• 16 Padget D. The development of the cranial arteries in the human embryo. Contrib Embryol 1948; 32: 207-261
• 17 Rhoton Jr AL. Microsurgical anatomy of the posterior fossa cranial nerves. Clin Neurosurg 1979; 26: 398-462
• 18 Jannetta PJ. Neurovascular cross-compression in patients with hyperactive dysfunction symptoms of the eighth cranial nerve. Surg Forum 1975; 26: 467-469
• 19 Jannetta PJ, Møller MB, Møller AR. Disabling positional vertigo. N Engl J Med 1984; 310 (26) 1700-1705
• 20 Lesinski SG, Chambers AA, Komray R, Keiser M, Khodadad G. Why not the eighth nerve? Neurovascular compression—probable cause for pulsatile tinnitus. Otolaryngol Head Neck Surg (1979) 1979; 87 (1) 89-94
• 21 McCabe BF, Harker LA. Vascular loop as a cause of vertigo. Ann Otol Rhinol Laryngol 1983; 92 (6 Pt 1) 542-543
• 22 Møller MB. Results of microvascular decompression of the eighth nerve as treatment for disabling positional vertigo. Ann Otol Rhinol Laryngol 1990; 99 (9 Pt 1) 724-729
• 23 Bachor E, Selig YK, Jahnke K, Rettinger G, Karmody CS. Vascular variations of the inner ear. Acta Otolaryngol 2001; 121 (1) 35-41
• 24 Kuncz A, Vörös E, Barzó P. Vascular compression syndromes of the cranial nerves. [in Hungarian]. Ideggyogy Sz 2011; 64 (1–2) 6-13
• 25 Eide PK, Slettebø H. Vascular compression and cranial nerve diseases. [in Norwegian]. Tidsskr Nor Laegeforen 1998; 118 (26) 4079-4084
• 26 Ryu H, Yamamoto S, Sugiyama K, Nishizawa S, Nozue M. Neurovascular compression syndrome of the eighth cranial nerve. Can the site of compression explain the symptoms?. Acta Neurochir (Wien) 1999; 141 (5) 495-501
• 27 Makins AE, Nikolopoulos TP, Ludman C, O'Donoghue GM. Is there a correlation between vascular loops and unilateral auditory symptoms?. Laryngoscope 1998; 108 (11 Pt 1) 1739-1742
• 28 Parnes LS, Shimotakahara SG, Pelz D, Lee D, Fox AJ. Vascular relationships of the vestibulocochlear nerve on magnetic resonance imaging. Am J Otol 1990; 11 (4) 278-281
• 29 Møller AR, Møller MB. Microvascular decompression operations. Prog Brain Res 2007; 166: 397-400