Repositioning Technique for the Decompression of Symptomatic Dolichoectatic Vertebrobasilar Pathology: A Comprehensive Review of Sling Characteristics and Surgical Experience

Objective: The repositioning of a dolichoectatic vertebrobasilar artery (VBA) for arterial decompression has been extensively used in the clinical setting. We aimed to describe and summarize the technical characteristics and clinical results of the sling technique. Methods: The terms “dolichoectatic aneurysm,” “dolichoectasia,” “ectasia,” and “megadolichoectasia” were used to search for pertinent reports related to the VBA territory. Studies related to the “decompression,” “repositioning,” “transposition,” “anchoring,” “pexy,” and “sling” techniques were screened, collected, and summarized by 1 of us (L.W.). Results: We identified 20 pertinent reports involving 59 cases. The sling repositioning techniques were divided into the following 4 subtypes: suture-lasso, vasculopexy, clip-lasso, and wrap-sling. Overall, 35 of the 59 patients (59.3%) were treated using the wrap-sling technique. Among these cases, Gore-Tex grafts were the most common sling material used. Of the cases with reported postoperative characteristics, all the patients except for 1 had experienced complete or significant remission of symptoms. Although 11 of the 59 patients (18.6%) had developed complications, the rate of adverse effects had decreased to 3.6% (2 of 55) during the long-term follow-up period (mean, 40.4 months; range, 2.1–168), and the outcomes were unremarkable in 54 of the 55 patients (98.2%). Conclusions: The excellent surgical outcomes and durable long-term results suggest that the repositioning technique is highly effective in resolving symptoms related to the compression of DVB pathology. The wrap-sling technique might be the preferred option owing to the simultaneous symptom relief and lower rate of temporary complications. However, cranial nerve manipulation should be meticulously implemented to avoid permanent negative effects.