Quantified EEG Cartography, Computerized Electro-Oculography in Hemodynamic Vertebrobasilar Insufficiency, Modifications Induced by Vertebral Artery Compression

2015 ◽  
pp. 235-238 ◽  
Author(s):  
C. Sebban ◽  
E. Vitte ◽  
G. Rancurel ◽  
K. Le Roch ◽  
G. Benkemoun ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Quantified Eeg ◽  
Vertebral Artery Compression

Rotational Vertebrobasilar Ischemia: Hemodynamic Assessment and Surgical Treatment

Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Marcelo D. Vilela ◽  
Robert Goodkin ◽  
David A. Lundin ◽  
David W. Newell
Keyword(s):  
Surgical Treatment ◽  
Vertebral Artery ◽  
Transcranial Doppler ◽  
Posterior Circulation ◽  
Long Term Results ◽  
Vertebrobasilar Insufficiency ◽  
Head Turning ◽  
Vertebrobasilar Ischemia ◽  
Hemodynamic Assessment ◽  
Vertebral Artery Compression

Abstract OBJECTIVE: Rotational vertebrobasilar insufficiency is a severe and incapacitating condition. Proper investigation and management are essential to reestablish normal posterior circulation hemodynamics, improve symptoms, and prevent stroke. We present a series of 10 patients with rotational vertebrobasilar ischemia who were treated surgically and emphasize the importance of transcranial Doppler in the diagnosis and management of this condition. METHODS: All patients presented with symptoms of vertebrobasilar insufficiency induced by head turning. Transcranial Doppler documented a significant decrease in the posterior cerebral artery velocities during head turning that correlated with the symptoms in all patients. A dynamic cerebral angiogram was performed to demonstrate the site and extent of vertebral artery compression. RESULTS: The surgical technique performed was tailored to each individual patient on the basis of the anatomic location, pathogenesis, and mechanism of the vertebral artery compression. Five patients underwent removal of osteophytes at the level of the subaxial cervical spine, one patient had a discectomy, two patients had a decompression only at the level of C1–C2, and two patients had a decompression and fusion at the C1–C2 level. CONCLUSION: The transcranial Doppler is extremely useful to document the altered hemodynamics preoperatively and verify the return of normal posterior circulation velocities after the surgical decompression in patients with rotational vertebrobasilar ischemia. Surgical treatment is very effective, and excellent long-term results can be expected in the vast majority of patients after decompression of the vertebral artery.

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.

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.

Rotational vertebrobasilar insufficiency as a component of thoracic outlet syndrome resulting in transient blindness

1994 ◽  
Vol 81 (4) ◽  
pp. 617-619 ◽  
Author(s):  
James J. Sell ◽  
Jesse R. Rael ◽  
William W. Orrison
Keyword(s):  
Vertebral Artery ◽  
Thoracic Outlet Syndrome ◽  
Head Rotation ◽  
Cortical Blindness ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Aged Woman ◽  
Extrinsic Compression ◽  
Vertebral Artery Compression

✓ Cases of unilateral vertebral artery compression associated with thoracic outlet syndrome infrequently result in symptoms and, of those that do, most involve the brain stem. Reports of transient blindness resulting from this condition are even more rare. The authors describe the case of a middle-aged woman who presented with transient blindness when she turned her head excessively to the left. She also exhibited other less severe brainstem symptoms. Arteriography demonstrated occlusion of the left vertebral artery only when her head was rotated to the left. Surgical exploration revealed entrapment of the left vertebral artery by a tight anterior scalene muscle, release of which resulted in complete resolution of her symptoms. Both neurosurgeons and radiologists need to be aware that extrinsic compression of the vertebral artery precipitated by head rotation may sometimes result in transient cortical blindness.

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.

Intracranial Vertebral Endarterectomy

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 465-471 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Balaji Sadasivan ◽  
Manuel Dujovny
Keyword(s):  
Vertebral Artery ◽  
Medical Therapy ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Temporal Artery ◽  
Superior Cerebellar Artery ◽  
Focal Lesion ◽  
Cerebellar Infarction ◽  
Vertebrobasilar Insufficiency ◽  
Cerebellar Artery

Abstract Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA). In this group, after endarterectomy, the vertebral artery was patent in two patients, and their symptoms resolved: in one patient the endarterectomy occluded, but the patient's symptoms improved; and in one patient the endarterectomy was unsuccessful, and he continued to have symptoms. In one patient, the plaque was at the origin of the PICA. The operation appeared technically to be successful, but the patient developed a cerebellar infarction and died. In one patient the stenosis was distal to the PICA. During endarterectomy, the plaque was found to invade the posterior wall of the vertebral artery. The vertebral artery was ligated, and the patient developed a Wallenburg syndrome. The results of superficial temporal artery to superior cerebellar artery anastomosis are better than those for intracranial vertebral endarterectomy for patients with symptomatic intracranial vertebral artery stenosis. The use of intracranial vertebral endarterectomy should be limited to patients who have disabling symptoms despite medical therapy, a focal lesion proximal to the PICA, and a patent posterior circulation collateral or bypass.

Atlanto-Occipital Decompression of Vertebral Artery for a Variant of Bow Hunter's Syndrome: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Nickalus R Khan ◽  
Turki Elarjani ◽  
Stephanie H Chen ◽  
Laszlo Miskolczi ◽  
Sheryl Strasser ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Rare Condition ◽  
Head Rotation ◽  
Treatment Modalities ◽  
Spinal Instability ◽  
Vertebrobasilar Insufficiency ◽  
Common Etiology ◽  
Neurologically Intact ◽  
Hunter's Syndrome ◽  
Visual Abnormalities

Abstract Rotational vertebral artery (VA) occlusion syndrome, also known as bow hunter's syndrome, is an uncommon variant of vertebrobasilar insufficiency typically occurring with head rotation.1-3 The most common presenting symptom is dizziness (76.8%), followed by visual abnormalities and syncope (50.4% and 40.4%, respectively).2 Osteophytic compression due to spinal spondylosis has been shown to be the most common etiology (46.2%), with other factors, such as a fibrous band, muscular compression, or spinal instability, being documented.1,2 Treatment is dependent on the level and site of VA compression with anterior, anterolateral, or posterior approaches being described.1,4 We present the case of a 72-yr-old male with osteophytic compression of the V3 segment of the vertebral artery at the occipital-cervical junction. The patient underwent a C1 hemilaminectomy and removal of osteophytic compression from the occipital-cervical joint. The patient had complete resolution of compression of his vertebral artery on postoperative imaging and remained neurologically intact following the procedure. We review the literature on this topic, the technical nuances of the procedure performed, and review the different treatment modalities available for this rare condition.1-11  The patient consented to the procedure and to publication of their image.

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.

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