Mehmet Erkan Ustun

Title: Collateral gains from vascular microsurgical intervention on the V1 segment dolicoarteriopathy of the vertebral artery: alleviating restless leg syndrome and urgency urinary incontinence symptoms in refractory vertebrobasilar insufficiency cases

Abstract

Background: This study assesses the efficacy of vascular microneurosurgical interventions on the V1 segment dolicoarteriopathies (grade 2 and 3 kinks) of the vertebral artery (VA) in patients with refractory vertebrobasilar insufficiency (VBI), manifesting as secondary benefits for restless leg syndrome (RLS) and urgency urinary incontinence (UUI).

Methods: We retrospectively reviewed 78 patients for RLS and UUI symptoms who underwent vascular procedures primarily for refractory VBI due to V1 segment dolicoarteriopathy. Depending on the severity of arterial kinking, the surgical techniques varied from arteriolysis to perivascular sympathectomy and graft positioning. Patients underwent diagnostic evaluations, including brain magnetic resonance imaging (MRI), brain and cervical MRI angiography, and preoperative as well as postoperative (at 3-month follow-up) perfusion studies utilizing Computerized Tomography (CT) perfusion studies.

Results: Significant symptomatic improvement was noted post-surgery, with 85.7% of patients experiencing complete resolution of RLS and substantially reducing UUI symptoms. The microneurosurgical approach resulted in complete remission of VBI-related symptoms in 87.8% of patients, with the rest showing partial or marked improvement. Regarding cerebral perfusion, 17 out of 20 patients showed objective improvements in perfusion studies in paracentral lobule, which translates to an 85% enhancement rate. This significant increase in perfusion correlates with symptomatic relief.

Conclusion: Vascular interventions for V1 segment dolicoarteriopathy are associated with clinical improvements in RLS and UUI symptoms, in addition to refractory VBI symptoms. The correlation between improved perfusion metrics and symptom resolution suggests a vascular contribution to the pathophysiology, emphasizing vascular assessment in refractory VBI cases.