COMPREHENSIVE ANALYSIS OF CONSERVATIVE AND SURGICAL TREATMENT APPROACHES FOR KIMMERLE ANOMALY

Abstract

Kimmerle anomaly is a congenital or acquired bony bridge of the atlas (C1 vertebra) that may compress the vertebral artery and cause vertebrobasilar insufficiency (VBI). The aim of this study was to analyze the effectiveness of conservative and surgical treatment in patients with symptomatic Kimmerle anomaly. A total of 23 patients aged 20–58 years were examined and treated at the Neurosurgical Department of Samarkand State Medical University from 2018 to 2024. Diagnostic evaluation included duplex ultrasonography with functional tests, MSCT angiography of the craniovertebral junction, and MRI of the brain. Conservative therapy (vasoactive agents, neuroprotectors, physiotherapy, cervical immobilization) achieved partial regression of symptoms in 39% of patients; however, recurrence occurred in over half of these cases. Surgical decompression of the vertebral artery, performed via median or paravertebral intermuscular approaches, resulted in complete or significant regression of symptoms in 79% of operated patients, with restoration of vertebral artery flow confirmed by Doppler studies. The results demonstrate the high efficacy and safety of minimally invasive decompression as a definitive treatment method for patients with refractory vertebrobasilar insufficiency caused by Kimmerle anomaly.