Powers’ anomaly: clinic, diagnosis and surgical treatment results

Abstract

Aim. To present the results of the complex clinical-instrumental diagnostics and surgical treatment of patients with Powers’ anomaly. Material and methods. The results of complex diagnostics, surgical treatment and medical examination of 6 patients (4 females and 2 males) with Powers’ anomaly at the age from 17 till 36 years old were analyzed. In all cases, the Powers anomaly was unilateral - in 4 cases, the right side and in 2 cases, the left side. According to the classification of A. V. Pokrovsky (1978), only one patient was asymptomatic and the rest had grade II or III chronic cerebrovascular insufficiency. Results and discussion. Except for one case, all the remaining patients had the main triad of VBI symptoms - dizziness, gait disturbance, and visual disturbances, which were indicative of severe brainstem and cerebellar ischemia. The diameter of the Powers anomaly in the first segment was 2.9 ± 0.81 mm and in the second segment was 3.6 ± 0.55 mm. There was also a decrease in the linear velocity of blood flow, and 2 patients had hypoplasia of the opposite vertebral artery. The average inflection angle of Powers’ anomaly in the near-osteal segment was 87.5 ± 10.5о. Conclusion. The nonspecific nature and similarity of clinical manifestations of Powers anomaly are the main causes of their late diagnosis and development of marked hemodynamic disturbances of the cerebral vertebrobasilar basin. Duplex scanning and contrast studies play a significant role in the diagnosis of hemodynamic abnormalities of the vertebrobasilar basin in Powers anomaly. The efficacy of reconstructive surgery for Powers’ anomaly in the long-term postoperative period is registered in all cases.