Vertebrobasilar insufficiency with underlying scalenus syndrome

Introduction. Compression of extracranial parts of the subclavian and vertebral arteries by neck muscles takes a certain place in the pathogenesis of cerebral circulation disorders.
Objectives. To study pathogenic mechanisms of vertebrobasilar insufficiency in sсalenus syndrome and to evaluate the results of surgical treatment.
Materials and methods. 68 patients with the scalenus syndrome (52 men and 16 women) aged 35 to 55 years were enrolled in the study. Patients were divided into two groups depending on the clinical manifestations: group I (38 patients) – patients with compression-irritative form and the group II (30 patients) – patients with reflex angiospastic form. Scalenotomy and arteriolysis were performed in group I. Scalenotomy and selective cervico-thoracic sympathectomy – in group II.
Results. The detailed description of the clinical picture was presented. Ultrasonic scanning with hyperabduction of the hand and Adson manoeuver revealed compression of the subclavian artery. Compression of the subclavian artery by the anterior scalene muscle was verified with the use of computed tomographic angiography. On scalenotomy it was found that autonomic vascular abnormalities were caused by the compression of the brachial plexus and subclavian artery in the interscalenum spatium and irritation of the autonomic nerves by the scalene muscles and surrounding fibrous-altered tissues. In all cases symptoms immediately diminished after the surgery.
Conclusion. Hemodynamic disturbances in extravasal compression of the subclavian and vertebral arteries by the anterior scalene muscle were confirmed by the effectiveness of scalenotomy. Disappearance of vertebral artery syndrome, hand ischemia symptoms and brachial plexus compression was observed clinically.