J Korean Neurosurg Soc.  2013 Sep;54(3):243-245. 10.3340/jkns.2013.54.3.243.

Rotational Vertebral Artery Compression : Bow Hunter's Syndrome

• Go G
• Hwang SH
• Park IS
• Park H

• KMID: 2190906
• DOI: http://doi.org/10.3340/jkns.2013.54.3.243

Abstract

Bow hunter's syndrome (BHS) is rare cause of vertebrobasilar insufficiency that arises from mechanical compression of the vertebral artery by head rotation. There is no standardized diagnostic regimen or treatment of BHS. Recently, we experienced 2 cases resisted continues medication and treated by surgical approach. In both cases, there were no complications after surgery and there were improvements in clinical symptoms. Thus, we describe our cases with surgical decompression with a review of the relevant medical literature.

Keyword

Bow hunter's syndrome; Rotational vertebral artery stroke; Vertebrobasilar insufficiency; Decompression; Surgical treatment

MeSH Terms

Decompression
Decompression, Surgical
Head
Mucopolysaccharidosis II*
Vertebral Artery*
Vertebrobasilar Insufficiency

Figure

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  Fig. 1 There is no definite vascular lesion on neck angiography 3D CT scans.

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  Fig. 2 A 50 year-old woman's right VA angiography with the head in a neutral position. B : The vertebral angiography is complete occluded when the head is fully rotated to the left.

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  Fig. 3 Hypoplastic left VA on angiography.

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  Fig. 4 Right transverse process of atlas was removed and right VA is decompressed sufficiently on neck three-dimensional angiography CT scans.

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  Fig. 5 At dynamic cerebroangiography, there are no steno-occlusive lesions of left VA in the neutral position. B: When the patient turns her head to the right, an occlusion of the left VA is observed at the C1-2 level.

Reference

1. Cornelius JF, George B, N'Dri Oka D, Spiriev T, Steiger HJ, Hanggi D. Bow-hunter's syndrome caused by dynamic vertebral artery stenosis at the cranio-cervical junction--a management algorithm based on a systematic review and a clinical series. Neurosurg Rev. 2012; 35:127–135. discussion 135. PMID: 21789571.

2. Diaz FG, Ausman JI, Shrontz C, Pearce J, Gehring R, Mehta B, et al. Surgical correction of lesions affecting the second portion of the vertebral artery. Neurosurgery. 1986; 19:93–100. PMID: 3748345.

3. Grossmann RI, Davis KR. Positional occlusion of the vertebral artery : a rare cause of embolic stroke. Neuroradiology. 1982; 23:227–230. PMID: 7121817.

4. Horowitz M, Jovin T, Balzar J, Welch W, Kassam A. Bow hunter's syndrome in the setting of contralateral vertebral artery stenosis : evaluation and treatment options. Spine (Phila Pa 1976). 2002; 27:E495–E498. PMID: 12461405.

5. Kuether TA, Nesbit GM, Clark WM, Barnwell SL. Rotational vertebral artery occlusion : A mechanism of vertebrobasilar insufficiency. Neurosurgery. 1997; 41:427–432. discussion 432-423. PMID: 9257311.

6. Lu DC, Gupta N, Mummaneni PV. Minimally invasive decompression of a suboccipital osseous prominence causing rotational vertebral artery occlusion. Case report. J Neurosurg Pediatr. 2009; 4:191–195. PMID: 19772401.

7. Matsuyama T, Morimoto T, Sakaki T. Comparison of c1-2 posterior fusion and decompression of the vertebral artery in the treatment of bow hunter's stroke. J Neurosurg. 1997; 86:619–623. PMID: 9120624.

8. Shimizu T, Waga S, Kojima T, Niwa S. Decompression of the vertebral artery for bow-hunter's stroke. Case report. J Neurosurg. 1988; 69:127–131. PMID: 3379466.

9. Sorensen BF. Bow hunter's stroke. Neurosurgery. 1978; 2:259–261. PMID: 732978.

10. Strupp M, Planck JH, Arbusow V, Steiger HJ, Bruckmann H, Brandt T. Rotational vertebral artery occlusion syndrome with vertigo due to "labyrinthine excitation". Neurology. 2000; 54:1376–1379. PMID: 10746615.

11. Tominaga T, Takahashi T, Shimizu H, Yoshimoto T. Rotational vertebral artery occlusion from occipital bone anomaly : a rare cause of embolic stroke. Case report. J Neurosurg. 2002; 97:1456–1459. PMID: 12507149.

12. Wakayama K, Murakami M, Suzuki M, Ono S, Shimizu N. Ischemic symptoms induced by occlusion of the unilateral vertebral artery with head rotation together with contralateral vertebral artery dissection--case report. J Neurol Sci. 2005; 236:87–90. PMID: 15979646.

13. Wang S, Wang C, Liu Y, Yan M, Zhou H. Anomalous vertebral artery in craniovertebral junction with occipitalization of the atlas. Spine (Phila Pa 1976). 2009; 34:2838–2842. PMID: 20010391.

14. Yang PJ, Latack JT, Gabrielsen TO, Knake JE, Gebarski SS, Chandler WF. Rotational vertebral artery occlusion at c1-c2. AJNR Am J Neuroradiol. 1985; 6:96–100. PMID: 3918425.