Far Lateral Approach for Microvascular Decompression of Ectatic Vertebral Artery-Associated Medullary Compression

Case Presentation: A 57-year-old male presented with progressive compressive bulbar symptoms, double vision, imbalance, and trouble swallowing food. Magnetic resonance angiography was obtained and demonstrated a dominant dilated right ventricular artery suggestive of ectasia which was compressing and effacing the medulla. Digital subtraction angiography redemonstrated the ectatic V4 segment of the vertebral artery which was large in caliber, traversed medially, and without evidence of any obvious aneurysm.