1. VASCULAR MALFORMATIONS IN THE BACKGROUND OF COCHLEO-VESTIBULAR SYMPTOMS Jarabin J, Nagy AL, Tanacs A, Czesznak A, Smehak Gy, Toth F, Rovo L, Jori J, Kiss JG. 1st International Symposium of Clinical and Applied Anatomy September 17-19, 2009, Novi Sad, Serbia

2. Neurovascular compression Neuro-vascular conflict is a pathophysiologic phenomenon which is implicated in several cranial neuropathies. The most common are:- trigeminal neuralgia and hemifacial spasm. Other phenomena are:- spasmodic torticolis - glosopharyngeal neuralgia - disabling positional vertigo - neurogenic hypertension - limited cases of tinnitus - fluctuating low frequency sensorineural hearing loss Current diagnostic approach comprises clinical and radiological evaluation. Along with complete otoneurological examination, MRI scans are essential to diagnose the conflict. This provides information about the presence of neuro-vascular conflict and involved structures.

3. Investigation methods Detailed anamnesis Otoneurological examinations Basic ENT examinations Spontaneous vestibular symptoms Caloric tests (Hallpike)‏ Audiometry Pure tone audiometry EABR DPOAE Impedance audiometry Radiological evaluation 3D FIESTA Hi Res 3DTOF HR 3D reconstructions with 3D Slicer Version 3.5 Alpha

4. Picture from Sobotta: Atlas Of Human Anatomy

5. Picture from János Vajda: Atlas anatomiae

6. Case hystory: Left sided low frequency hearing loss and pulsating tinnitus. Accompanied imbalance is also present. Radiology: MRI scan+angiography MRI scan+angiography revealed the underlying vascular malformation: the anterior inferior cerebellar artery’s (AICA) vascular kinking conflicts with the cochlear nerve Case report: J.P. 52 year-old woman Impedance audiometry: „A” type tympanogram Left side missing stapedial rfx DPOAE: missing OHC activity left side EABR: within normal ranges Otoneurology: normal finding SN hearing loss on the left side

7. 3D reconstruction model

8. Case hystory: Left sided pulsating, low frequency tinnitus. Otherwise asymptomatic. Radiology: MRI scan+angiography MRI scan+angiography revealed the underlying vascular malformation: vascular loop conflicts the entry zone of the nerve VII-VIII. Case report: I.F. 41 year-old woman Impedance audiometry, DPOAE, EABR: within normal ranges Otoneurology: no detectable vestibular lesion.

9. 3D reconstruction model

10. Summary There are several cranial neuropathies including some vestibulo-cochlear symptoms which can be traced back to neuro-vascular conflicts. After a thorough case history taking and ENT examination the suspicion of the underlying compression can be revealed. For the verification of our hypothesis High Resolution MRI+angiography scans are essential to be performed. Using 3D Slicer Ver. 3.5 alpha software for reconstructing 3D models from the conventional MRI scans it is available also for clinicians to visualize the underlying vascular conflicts. Microvascular decompression (MVD) is the treatment of choice, which can be facilitated by the 3D models.