LAUSR

Vertebrobasilar dolichoectasia may present with compression on the brainstem or surrounding cranial nerves. The surgical management for this pathology may include microvascular decompression, sling-based macrovascular decompression, or, as presented here, a novel rerouting of the artery using reanastomosis bypass. This unique video demonstrates the pathology of this case and why it is not amenable to typical macrovascular decompression, as well as the execution of the novel "binder ring" bypass, which includes transecting the offending vessel, rerouting it around the cranial nerves, and reanastomosis.1 A man in his early 70s who presented with symptomatic compression underwent a left retrosigmoid craniotomy to expose the distal tortuous vertebral artery, which displaced the left cranial nerve VII/VIII complex in the cerebellopontine angle. This segment was trapped with temporary aneurysm clips, transected, and the ends of the artery were then mobilized away from the nerves. The ends were brought back together in a comfortable position lateral to the cranial nerves. A V4-V4 end-to-end reanastomosis (V4 [E-Ec*] V4 bypass) was performed with a fourth-generation bypass technique, using intraluminal suturing for the deep suture line. The patient enjoyed complete symptomatic relief thereafter, with normal hearing. The relief of symptoms is believed to be attributable to cranial nerve decompression rather than to brainstem decompression. The patient provided written informed consent for treatment. Used with permission from Barrow Neurological Institute.