# A Case With Twists and Turns: A Report of Vertebrobasilar Dolichoectasia

## TL;DR

This case report describes a rare condition called vertebrobasilar dolichoectasia that presented with symptoms resembling trigeminal neuralgia and showed limited treatment success.

## Contribution

The paper presents an atypical case of VBD mimicking trigeminal neuralgia and highlights the lack of effective treatment options.

## Key findings

- The patient's VBD mimicked trigeminal neuralgia by compressing the trigeminal nerve.
- Medical and surgical treatments, including gamma knife therapy, failed to relieve symptoms.
- Current management of VBD lacks definitive guidelines or successful therapies.

## Abstract

Vertebrobasilar dolichoectasia (VBD) is a rare anatomical abnormality of the vertebral artery system, defined as irregular expansion, elongation, and tortuosity of vertebral arteries. Anomalies of the vertebrobasilar artery can have a wide variety of clinical presentations, ranging from simple headaches to debilitating strokes. We present the case of an atypical presentation of VBD which mimicked trigeminal neuralgia by compressing the trigeminal nerve. There are currently no guidelines concerning the management of VBD, nor is there evidence of a definitive cure. This case invoked discussions among the medical team as to whether management should be medically or surgically focused, as well as long-term outcomes for patients with VBD. The superiority of medical versus surgical treatment of this issue is still a debated topic. This patient trialed medical management with dexamethasone and carbamazepine with no improvement in symptoms. He then underwent surgical gamma knife treatment but even this invasive measure was unsuccessful at relieving his symptoms. We hope that by presenting this case, we can display how the therapies available for VBD are limited and often unsuccessful in relieving the disease burden in patients with VBD.