====== Vertebrobasilar dolichoectasia treatment ======

The best conventional management of [[Vertebrobasilar dolichoectasia]] may be the control of [[arterial hypertension]]. According to series studies, arterial hypertension not only plays a role in the formation and enlargement of intracranial dolichoectasia, but also contributes to the increased incidence of both ischemic stroke and [[intracranial hemorrhage]]
((Pico F, Labreuche J, Touboul PJ, et al. Intracranial arterial dolichoectasia and its relation with atherosclerosis and stroke subtype. Neurology. 2003;61:1736–42.))
((Passero SG, Calchetti B, Bartalini S. Intracranial bleeding in patients with vertebrobasilar dolichoectasia. Stroke. 2005;36:1421–5.)).

Risk of bias in the studies are too high to make any recommendation regarding treatment
((Wolters FJ, Rinkel GJ, Vergouwen MD. Clinical course and treatment of
vertebrobasilar dolichoectasia: a systematic review of the literature. Neurol
Res. 2013 Mar;35(2):131-7. doi: 10.1179/1743132812Y.0000000149. Review. PubMed
PMID: 23452575.
)).
----
If the condition of the patients is stable and benign, they can be treated with medication or stent reconstruction. Given the serious complications that can be caused by open surgery, care must be taken when selecting the patients to be treated using open surgery, but more studies are needed to support this conclusion. The key points are to avoid aneurysm thrombosis and maintain patency of the perforators
((Zhang H, Shi M, Tong X. Treatment of Symptomatic Dolichoectatic
Vertebrobasilar Aneurysms: A Single-Center Experience with 12 Patients. World
Neurosurg. 2018 Nov;119:e407-e416. doi: 10.1016/j.wneu.2018.07.176. Epub 2018 Jul
30. PubMed PMID: 30071326.
)).
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[[Transposition]] techniques are often required to decompress the [[brainstem]] with dolichoectatic pathology. 

When indicated, the operative techniques utilized to address vertebrobasilar artery [[dolichoectasia]] must be individually tailored, can be technically challenging, and have been rarely expounded.

The [[surgical technique]]s that Barrow and Ellis from the [[Emory University Hospital]] and [[Lenox Hill Hospital]], have employed to alleviate the compression, included simple decompression as well as sling-assisted arterial transposition. The evolution and refinement of ther transposition technique are detailed.

A wide range of pathological conditions may result from compression of neural structures throughout the course of the [[vertebrobasilar system]]. Compression of [[cervical nerve root]]s, the [[spinal cord]], [[brainstem]], and [[cranial nerve]]s can be seen. Microsurgical management may be indicated in selected cases with gratifying results.

Pathological compression of neural structures throughout the course of the vertebrobasilar system should be recognized. When indicated, microsurgical decompression must be tailored to the individual symptomology and the unique anatomic relationship in each case with the potential to prevent neurological worsening and, in many cases, improve functional outcome
((Barrow DL, Ellis JA. Microsurgical Strategies for the Treatment of Compression
Neuropathies Secondary to Vertebrobasilar Dolichoectasia: From Simple
Decompression to Sling Transposition. Oper Neurosurg (Hagerstown). 2018 Dec 27.
doi: 10.1093/ons/opy391. [Epub ahead of print] PubMed PMID: 30590732.
)).