Article Figures & Data
Figures
- Fig 1.
Grading system. The vagus nerve was rated separately for the proximal (3 mm from the brain stem) and the distal portions. A, Grade I: “no vessel contact” (white arrow). B, Grade II: “contact,” which was defined as no visible CSF between the blood vessel and the nerve but no displacement of the normal trajectory of the nerve (white arrow). C, Grade III: “compression,” which was defined as displacement of the normal trajectory of the nerve (white arrow). D, Grade I: Oblique projection showing the vagus nerve (white arrow) in contact with the PICA (black arrow). The glossopharyngeal nerve (gray arrow) is shown above the vagus nerve. E, Oblique projection of the IX/X complex close to the jugular foramen. It was possible to see the upper glossopharyngeal nerve more anteriorly and superiorly moving lateral into the foramen, and the vagus nerve branches were below this.
- Fig 2.
Patient 1. A, MR imaging shows neurovascular conflict of the PICA (arrow) with the proximal part of the vagus nerve. B, Intraoperative findings show the loop of the PICA (asterisk) pulsating against the caudal rootlets of the vagus nerve (X). IX indicates glossopharyngeal nerve; crXI, cranial root of the accessory nerve; S, superior; I, inferior; R, right; L, left.
- Fig 3.
Patient 2. A, Axial view of MR imaging shows compression of the vagus nerve by the right PICA from the anterior direction (arrow). B, The coronal-oblique plane shows the vessel loop of the PICA (arrow). VII/VIII indicates the facial and vestibulocochlear nerve complex; IX/X, the glossopharyngeal and vagus nerve complex. C, Intraoperative findings confirm that the vessel loop of the PICA (arrow) is pulsating against the anterior aspect of the vagus nerve (X). IX indicates the glossopharyngeal nerve; XI, the accessory nerve; S, superior; I, inferior; R, right; L, left.
- Fig 4.
Case 3. A, Axial view of MR imaging shows neurovascular conflict of the left PICA (asterisk) and the vagus nerve. B, The coronal-oblique plane shows the loop of the left PICA (asterisk) in contact with the proximal part of the rootlets of the vagus nerve (X), which is also in contact with the left cerebellar tonsil (T). C, Intraoperative findings. After gentle retraction of the cerebellum and part of the left tonsil, the left PICA loop (asterisk) is found in contact with the proximal part of the vagus nerve (X). S indicates superior; I, inferior; R, right; L, left.
Tables
Clinical and demographic data of our patients with HELPS
Patient No. Age/Sex Symptoms Offending Vessel Grading of NVC 1 65/M Episodic throat contractions and coughing Left PICA 2 2 43/F Episodic throat contractions, coughing, and vocal changes Right PICA 3 3 32/F Episodic left-sided throat contractions, choking, and vocal changes Left PICA 2 Note:—NVC indicates neurovascular conflict.
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