A 72-Year-Old Female With Bow Hunter Syndrome: A Rare Surgical Approach to C4-5 Vertebral Artery Decompression: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E310-E310
Author(s):  
Michael J Gigliotti ◽  
Jacob Joseph ◽  
Byron Gregory Thompson ◽  
Paul Park
Keyword(s):  
Vertebral Artery ◽  
Dynamic Testing ◽  
Hunter Syndrome ◽  
Operative Intervention ◽  
Vertebrobasilar Insufficiency ◽  
Symptomatic Disease ◽  
Ct Angiogram ◽  
Preoperative Ct ◽  
The Right ◽  
Operative Neurosurgery

Abstract Bow hunter syndrome is defined as vertebrobasilar insufficiency due to mechanical occlusion of the vertebral artery during head and neck rotation. In many cases, this is due to osteophyte formation, disc herniation, cervical spondylosis, tendinous bands, or tumors. Symptomatic disease may vary from inducing transient vertigo to posterior circulation stroke. Although digital subtraction angiography is the gold standard in diagnosis, the underlying pathology in bow hunter syndrome may be detected with doppler ultrasound, computed tomography (CT) angiogram, magnetic resonance imaging and angiogram, and diagnostic angiography with dynamic testing. In this case, a 72-yr-old female with a recent right-sided cerebellar stroke underwent operative intervention to decompress the right vertebral artery at C4-C5 in order to relieve symptomatic bow hunter syndrome. Preoperative CT angiogram revealed bilateral significant stenosis of the vertebral arteries at the C4-C5 level with follow-up diagnostic angiogram revealing complete occlusion of the right vertebral artery with the head rotated right (compared to 80% occlusion observed when the patient's head was rotated left). Prior to the procedure, the patient experienced lightheadedness, diaphoresis, dizziness, and a sensation of facial flushing exacerbated by rotating her head to the right. To relieve her symptoms, operative intervention was undertaken. To access the lateral osteophytes originating from the uncovertebral joint, a C4-5 discectomy is utilized. The vertebral artery was decompressed, and a standard anterior cervical fusion was performed. Postoperatively, the patient was stable and was discharged 1 d after surgery. Postoperative imaging showed adequate decompression of the right vertebral artery at the level of C4-5.  The authors confirm that they have obtained, prior to submission, a written release from the patient authorizing use of this surgical video to be submitted and published in the journal Operative Neurosurgery, as well as consent to perform the procedure.

Vertebral Artery Disease

2015 ◽  
Author(s):  
Gregory J. Pearl ◽  
William P. Shutze
Keyword(s):  
Vertebral Artery ◽  
Posterior Circulation ◽  
Circulation System ◽  
Common Disease ◽  
Vertebrobasilar Insufficiency ◽  
Disease Patterns ◽  
Collateral Pathways ◽  
Artery Disease ◽  
The Right ◽  
Evaluation Patterns

Vertebral artery disease (VAD) is a significant cause of severe symptoms or stroke. Approximately 25 to 30% of strokes involve the posterior circulation system; VAD will be present in 20% of these and will be the source in about 10%. The ability to properly diagnose, manage, and treat VAD is an important skill for practitioners caring for patients with extracranial cerebral occlusive disease. This review covers anatomy, presentations of VAD, evaluation, patterns of disease, treatment, and other vertebral artery (VA) syndromes. Tables outline symptoms and differential diagnoses of vertebrobasilar insufficiency, etiologies of VA compression syndromes, posterior circulation cerebrovascular accident symptoms and associated syndromes, and ultrasonography velocity and VA stenosis. Figures show the anatomy of the VA, circle of Willis, aberrant arteries, VA compression, ischemic posterior circulation, collateral pathways to the VA, common disease patterns in VAD, VA to carotid artery anastomosis, incision for the V3 bypass, VA aneurysm, VA dissection, angiography of the right VA, giant cell arteritis, and fibromuscular dysplasia. Radiologic videos are provided. This review contains 15 figures, 6 tables, 7 videos, and 71 references.

SUCCESSFUL STENTING BY COMBINATION TECHNIQUE OF REVERSE FLOW AND DOWNSTREAM FILTERING FOR LONG CHRONIC TOTAL OCCLUSION OF THE CERVICAL VERTEBRAL ARTERY

Neurosurgery ◽  
2009 ◽  
Vol 65 (2) ◽  
pp. E378-E379 ◽  
Author(s):  
Tomonori Iwata ◽  
Takahisa Mori ◽  
Hiroyuki Tajiri ◽  
Masahito Nakazaki
Keyword(s):  
Vertebral Artery ◽  
Chronic Total Occlusion ◽  
Reverse Flow ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebrobasilar Insufficiency ◽  
Total Occlusion ◽  
Combination Technique ◽  
Left Posterior ◽  
The Right ◽  
Distal Filter

Abstract OBJECTIVE To report a case of successful recanalization using the combination technique of reverse flow and downstream filtering in chronic total occlusion of the bilateral vertebral artery (VA). Clinical Presentation A 59-year-old man had experienced attacks consisting of vertigo and/or dysarthria more than 1 year before presentation. He experienced symptoms despite the administration of antiplatelet drugs and presented to our institution. Diagnostic cerebral angiography demonstrated that the right VA was not occluded at the ostium but, rather, along its midcervical portion and that the left VA ended in the left posterior inferior cerebellar artery. Intervention Long chronic total occlusion of the right cervical VA was recanalized successfully and safely by reverse flow and downstream filtering with proximal flow blockade and a distal filter device positioned in the right brachial artery. Follow-up angiography at 1 year demonstrated no re-occlusion. The patient's symptoms disappeared after recanalization and did not recur. To our knowledge, there are no reports describing successful angioplasty and/or stenting for long chronic total occlusion of the cervical VA. CONCLUSION Stenting using the combination technique of reverse flow and downstream filtering can safely open even long chronic cervical VA occlusion and may be effective in the treatment of patients experiencing vertebrobasilar insufficiency due to bilateral chronic VA occlusion.

Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band

1982 ◽  
Vol 56 (4) ◽  
pp. 581-583 ◽  
Author(s):  
Timothy Mapstone ◽  
Robert F. Spetzler
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Vertebrobasilar Insufficiency ◽  
Fibrous Band ◽  
Content Type ◽  
Vertebral Artery Occlusion ◽  
The Right ◽  
Band Crossing ◽  
Fine Print

✓ A case is described in which vertebral artery occlusion, caused by a fibrous band, occurred whenever the patient turned his head to the right side, resulting in vertigo and syncope whenever the head was turned to the right. Release of a fibrous band crossing the vertebral artery 2 cm from its origin relieved the patient's vertebral artery constriction and symptoms.

scholarly journals Dimensions and Anatomical Variants of the Foramen Transversarium of Typical Cervical Vertebrae

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Santosh Kaur Sangari ◽  
Paul-Michel Dossous ◽  
Thomas Heineman ◽  
Estomih Phillip Mtui
Keyword(s):  
Vertebral Artery ◽  
Thrombus Formation ◽  
Cervical Vertebrae ◽  
Uncinate Process ◽  
Vertebrobasilar Insufficiency ◽  
Transverse Foramen ◽  
Medial Margin ◽  
Significant Difference ◽  
The Mean ◽  
The Right

The study was conducted on random sample of seventy-one dried, typical cervical vertebrae (C3–C6). The data on the age, sex, and built was not available. Using vernier calipers with 0.01 mm accuracy, the anteroposterior and transverse diameters of transverse foramina and their distance from the medial margin of the uncinate process were measured bilaterally. The mean diameter of the right/left transverse foramen varied from 2.54 mm to 7.79 mm (mean = 5.55 ± 0.87 mm) and from 2.65 mm to 7.35 mm (mean = 5.48 ± 0.77 mm), respectively. The transverse foramen was less than 3.5 mm in three vertebrae on the right and two on the left. The osteocytes observed in 21.3% of specimens and the narrow transverse foramen may place patients at risk for vertebrobasilar insufficiency or thrombus formation. The mean distance of the transverse foramen from the medial margin of uncinate process is an important landmark to avoid vertebral artery laceration and was 5.0 ± 0.87 mm (range: 3.5–7.9 mm) on the right and 5.0 ± 1.0 mm (range: 3.2–7.7 mm) on the left side. No statistically significant difference was observed between the right and left sides. The accessory transverse foramina seen in 24% of vertebrae suggest duplications or fenestrations in the vertebral artery.

scholarly journals Atypical presentation of rotational vertebral artery insufficiency: illustrative case

2021 ◽  
Vol 1 (9) ◽  
Author(s):  
Pranish A. Kantak ◽  
Sarv Priya ◽  
Girish Bathla ◽  
Mario Zanaty ◽  
Patrick W. Hitchon
Keyword(s):  
Vertebral Artery ◽  
Facet Joint ◽  
Head Rotation ◽  
Rotational Instability ◽  
Anatomical Location ◽  
Illustrative Case ◽  
Vertebrobasilar Insufficiency ◽  
Course Of Action ◽  
Heterogeneous Nature ◽  
The Right

BACKGROUNDRotational vertebral artery insufficiency (RVAI), also known as bow hunter’s syndrome, is an uncommon cause of vertebrobasilar insufficiency that leads to signs of posterior circulation ischemia during head rotation. RVAI can be subdivided on the basis of the anatomical location of vertebral artery compression into atlantoaxial RVAI (pathology at C1-C2) or subaxial RVAI (pathology below C2). Typically, RVAI is only seen with contralateral vertebral artery pathologies, such as atherosclerosis, hypoplasia, or morphological atypia.OBSERVATIONSThe authors present a unique case of atlantoaxial RVAI due to rotational instability, causing marked subluxation of the C1-C2 facet joints. This case is unique in both the mechanism of compression and the lack of contralateral vertebral artery pathology. The patient was successfully treated with posterior C1-C2 instrumentation and fusion.LESSONSWhen evaluating patients for RVAI, neurosurgeons should be aware of the variety of pathological causes, including rotational instability from facet joint subluxation. Due to the heterogeneous nature of the pathologies causing RVAI, care must be taken to decide if conservative management or surgical correction is the right course of action. Because of this heterogeneous nature, there is no set guideline for the treatment or management of RVAI.

scholarly journals Bow hunter syndrome in rheumatoid arthritis: illustrative case

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Brian P. Curry ◽  
Vijay M. Ravindra ◽  
Jason H. Boulter ◽  
Chris J. Neal ◽  
Daniel S. Ikeda
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Vertebral Artery ◽  
Hunter Syndrome ◽  
Left Vertebral Artery ◽  
Illustrative Case ◽  
Vertebrobasilar Insufficiency ◽  
Vascular Insufficiency ◽  
Vertebral Artery Compression ◽  
Spine Disease

BACKGROUND Rheumatoid arthritis (RA) frequently features degeneration and instability of the cervical spine. Rarely, this degeneration manifests as symptoms of bow hunter syndrome (BHS), a dynamic cause of vertebrobasilar insufficiency. OBSERVATIONS The authors reviewed the literature for cases of RA associated with BHS and present a case of a man with erosive RA with intermittent syncopal episodes attributable to BHS as a result of severe extrinsic left atlantooccipital vertebral artery compression from RA-associated cranial settling. A 72-year-old man with RA-associated cervical spine disease who experienced gradual, progressive functional decline was referred to a neurosurgery clinic for evaluation. He also experienced intermittent syncopal events and vertiginous symptoms with position changes and head turning. Vascular imaging demonstrated severe left vertebral artery compression between the posterior arch of C1 and the occiput as a result of RA-associated cranial settling. He underwent left C1 hemilaminectomy and C1–4 posterior cervical fusion with subsequent resolution of his syncope and vertiginous symptoms. LESSONS This is an unusual case of BHS caused by cranial settling as a result of RA. RA-associated cervical spine disease may rarely present as symptoms of vascular insufficiency. Clinicians should consider the possibility, though rare, of cervical spine involvement in patients with RA experiencing symptoms consistent with vertebral basilar insufficiency.

Rotational obstruction of nondominant vertebral artery and ischemia

1996 ◽  
Vol 85 (3) ◽  
pp. 507-509 ◽  
Author(s):  
Tetsuya Morimoto ◽  
Takanobu Kaido ◽  
Yoshitomo Uchiyama ◽  
Hidemori Tokunaga ◽  
Toshisuke Sakaki ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Three Dimensional ◽  
Artery Occlusion ◽  
Left Vertebral Artery ◽  
Posterior Fixation ◽  
Vertebrobasilar Insufficiency ◽  
Atlantoaxial Joint ◽  
Head Turning ◽  
Content Type ◽  
The Right

✓ A 70-year-old man presented with repeated vertebrobasilar insufficiency for 3 years. Four-vessel angiography revealed complete occlusion of the nondominant left vertebral artery on head turning to the right. Three-dimensional computerized tomography angiography demonstrated atlantoaxial joint dislocation when the head was turned to the right, in accordance with simultaneous occlusion of the left vertebral artery caused by stretching of the artery at C1–2. After posterior fixation of C1–2 by a Halifax interlaminar fixation system, the patient had no further episodes. Hemodynamic function associated with nondominant vertebral artery occlusion contributed to the symptoms in this case.

Positional vertebral artery compression and vertebrobasilar insufficiency due to a herniated cervical disc

2009 ◽  
Vol 11 (3) ◽  
pp. 326-329 ◽  
Author(s):  
Kenta Ujifuku ◽  
Kentaro Hayashi ◽  
Keishi Tsunoda ◽  
Naoki Kitagawa ◽  
Tomayoshi Hayashi ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Histopathological Examination ◽  
Head Rotation ◽  
Cervical Disc ◽  
Decompression Surgery ◽  
Vertebrobasilar Insufficiency ◽  
Intraoperative Angiography ◽  
The Right ◽  
Vertebral Artery Compression ◽  
Herniated Cervical Disc

The authors report a case of vertebrobasilar insufficiency caused by vertebral artery (VA) compression due to a herniated cervical disc, which was surgically treated with the aid of intraoperative angiography. This 78-year-old man visited the hospital because of syncope following head rotation. Admission CT scans revealed a calcified mass adjacent to the right lateral process of the C-4 spine. Cervical angiography demonstrated an obstruction of the right VA at this region on rotation of the head to the right. The operation revealed a cervical disc protruding toward the right VA. The disc was surgically removed, and then the decompression of the right VA was confirmed on intraoperative angiography studies. A histopathological examination showed fibrohyaline cartilage, indicating an ossified intervertebral disc. The postoperative course was uneventful, and he has not experienced any syncope since treatment. A cervical disc herniation could be a cause of vertebrobasilar insufficiency by exerting positional compression of the VA. Intraoperative angiography could be quite useful to confirm this condition during decompression surgery for a cervical VA.

scholarly journals A Case of Rotational Vertebral Artery Syndrome after Vertebral Artery Dissection

2020 ◽  
Vol 63 (5) ◽  
pp. 228-232
Author(s):  
Song Jae Lee ◽  
Ha Young Byun ◽  
Seung Hwan Lee ◽  
Jae Ho Chung
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Anticoagulation Therapy ◽  
Hunter Syndrome ◽  
Artery Dissection ◽  
Mechanical Compression ◽  
Transverse Foramen ◽  
Phase Dynamic ◽  
Close Observation ◽  
The Right

Rotational vertebral artery syndrome (RVAS), also called Bow-Hunter syndrome, is characterized by position-aggravated reversible vertebra-basillarischemia. By rotating the head to one side, the mechanical compression of a dominant vertebral artery (VA) in the setting of a hypoplastic contralateral VA might cause tinnitus, vertigo and syncope. A 60-year-old male experienced recurrent tinnitus and vertigo while rotating the head to the right side. Neck CT images showed no abnormal structures near the course of both VAs. In 3-phase dynamic neck CT angiography, a focal vertebral artery dissection was identified at the right C6 transverse foramen. Close observation and anticoagulation therapy were started to prevent thrombo-embolic complications. Herein, we report a case of RVAS with vertebral artery dissection with a review of the literatures.

scholarly journals Fusion for subaxial bow hunter’s syndrome results in remote osseous remodeling of the hyperostotic growth responsible for vertebral artery compression

2021 ◽  
Vol 12 ◽  
pp. 104
Author(s):  
Daniel Satoshi Ikeda ◽  
Charles A. Miller ◽  
Vijay M. Ravindra
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Complete Resolution ◽  
Dynamic Compression ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Head Rotation ◽  
Vertebrobasilar Insufficiency ◽  
The Right ◽  
Vertebral Artery Compression ◽  
Hunter's Syndrome

Background: The authors present a previously unreported case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) who developed bow hunter’s syndrome (BHS) or positional vertebrobasilar insufficiency. In addition, the authors demonstrate angiographic evidence of remote osseous remodeling after segmental fusion without direct decompression of the offending bony growth. BHS is a rare, yet well established, cause of posterior circulation ischemia and ischemic stroke. Several etiologies such as segmental instability and spondylosis have been described as causes, however, DISH has not been associated with BHS before this publication. Case Description: A 77-year-old man who presented with BHS was found to have cervical spine changes consistent with DISH, and angiography confirmed right vertebral artery (VA) stenosis at C4–5 from a large pathological elongation of the right C5 lateral mass. Head rotation resulted in occlusion of the VA. The patient underwent an anterior cervical discectomy and fusion and reported complete resolution of his symptoms. A delayed angiogram and CT of the cervical spine demonstrated complete resolution of the baseline stenosis, no dynamic compression, and remote osseous remodeling of the growth, respectively. Conclusion: This case represents the first publication in the literature of DISH as a causative etiology of BHS and of angiographic data demonstrating resolution of a compressive osseous pathology without direct decompression in BHS.

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