[Microsurgery of the vertebral arteries in vertebrobasilar insufficiency].

The low efficacy of nonoperative management of patients with vertebrobasilar insufficiency (VBI) made the development of a surgical method necessary. Twenty-eight patients with VBI were examined and operated on. Transient circulatory disorders in the vertebrobasilar channel were the main indications for the operation. Of special value among the instrumental diagnostic methods was ultrasonic dopplerography, particularly the Doppler clinical test with digital compression of the vertebral artery (VA). Angiography helped in precise determination of the character and level of the pathological process. Three approaches to three extracranial parts of the VA were used, 15 operations were conducted on the initial part of the VA, 6--on the VA in the osteomuscular canal, and 2--at the level of C1-C2. The abnormal twisting was corrected during the operation, the thyrocervical trunk was ligated, and different variants of decompression of the VA compressed by adhesions, changed muscles, osteophytes, etc. were applied. The operations were carried out with the use of a microscope and microsurgical instruments as a result of which the number of complications reduced. There were no fatal outcomes, a favourable result was produced in 21 patients, the operation had no effect in 2 patients. Microsurgical treatment of VBI is a highly effective method which causes little injury.