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.

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 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.

Rotational vertebral artery occlusion: Case report and review of literature

2018 ◽  
pp. 1-3
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Transcranial Doppler Ultrasound ◽  
Artery Occlusion ◽  
Vascular Lesion ◽  
Vascular Compression ◽  
Vertebrobasilar Insufficiency ◽  
Transverse Foramen ◽  
Vertebral Artery Occlusion ◽  
The Right

Rotational vertebral artery occlusion (RVAO) classically involves transient, position-dependent vertebrobasilar insufficiency (VBI) that occurs when an extra-vascular lesion (e.g. osteophyte or fibromuscular band) compresses a dominant vertebral artery with turning of the head to one side. Our patient presented with VBI associated vertigo, dizziness, and lightheadedness that occurred when her head was turned to the right. RVAO was initially suggested by transcranial Doppler ultrasound (TCD) changes that were not supported by initial catheter angiography. After her symptoms worsened over a course of two years, the diagnosis was confirmed with repeat angiography with head rotation. Further imaging with computed tomography and magnetic resonance demonstrated spondylosis at the C5-C6 vertebrae and an osteophyte near the C5 transverse foramen, which caused position-dependent extra-vascular compression. She was treated with surgical decompression and anterior discectomy and fusion at C5-C6. The unique anatomical pathology of this case combined with the diagnostic discrepancy between early TCD and angiography make it an interesting contribution to the otherwise limited body of literature on RVAO.

Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery

1995 ◽  
Vol 83 (4) ◽  
pp. 737-740 ◽  
Author(s):  
Mark W. Fox ◽  
David G. Piepgras ◽  
John D. Bartleson
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Artery Occlusion ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Mechanical Compression ◽  
Head Turning ◽  
Content Type ◽  
The Right ◽  
Bow Hunter’S Stroke

✓ A case of repeated vertebrobasilar ischemic attacks related to head rotation (bow hunter's stroke) is reported. With head rotation of 45° or more to the right, the patient would become lightheaded and feel as if she were going to lose consciousness. Angiography performed when head rotation was to the right revealed mechanical compression of the left vertebral artery at the foramen transversarium of the axis and an occluded right vertebral artery. Untethering of the vertebral artery as it passed through the foramen transversarium of the atlas in this case completely relieved the patient's symptoms. The authors conclude that contralateral vertebral artery occlusion predisposed this patient to symptomatic vertebrobasilar insufficiency secondary to ipsilateral vertebral artery mechanical stenosis induced by head turning.

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.

Giant Pseudoaneurysm of the Extracranial Vertebral Artery Successfully Treated Using Intraoperative Balloon Catheters

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 738-742 ◽  
Author(s):  
Junya Hanakita ◽  
Hideyuki Suwa ◽  
Kiyoshi Nishihara ◽  
Koji Iihara ◽  
Hiroshi Sakaida
Keyword(s):  
Vertebral Artery ◽  
Cardiac Pacemaker ◽  
Innominate Artery ◽  
Anatomical Location ◽  
High Morbidity ◽  
Vertebrobasilar System ◽  
Balloon Catheters ◽  
Extracranial Vertebral Artery ◽  
The Right ◽  
Giant Pseudoaneurysm

Abstract Traumatic pseudoaneurysms of the extracranial vertebral artery rarely occur, because of its deeply protected anatomical location. Because the direct surgical approach has resulted in high morbidity and mortality rates, ligation of the vertebral artery has been adopted, but this can cause an ischemia in the vertebrobasilar system. We report the case of a 73-year-old woman with a huge pseudoaneurysm of the right vertebral artery that occurred after attempted placement of a cardiac pacemaker. The aneurysm was 7 x 7 x 5 cm in size and its neck was situated just distal to the right subclavian artery. Direct surgical repair of the injured vessel and removal of the aneurysm were successfully performed using balloon catheters placed intraoperatively in both the innominate artery and the right vertebral artery.

scholarly journals Digital intravascular pressure wave recording during endovascular treatment reveals abnormal shunting flow in vertebral venous fistula of the vertebral artery: illustrative case

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Yoshiteru Shimoda ◽  
Shinya Sonobe ◽  
Kuniyasu Niizuma ◽  
Toshiki Endo ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Blood Flow ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Resistance Index ◽  
Illustrative Case ◽  
Limb Weakness ◽  
Dicrotic Notch ◽  
The Central Nervous System ◽  
Venous Fistula ◽  
The Right

BACKGROUND An arteriovenous fistula is an abnormal arteriovenous shunt between an artery and a vein, which often leads to venous congestion in the central nervous system. The blood flow near the fistula is different from normal artery flow. A novel method to detect the abnormal shunting flow or pressure near the fistula is needed. OBSERVATIONS A 76-year-old woman presented to the authors’ institute with progressive right upper limb weakness. Right vertebral angiography showed a fistula between the right extracranial vertebral artery (VA) and the right vertebral venous plexus at the C7 level. The patient underwent endovascular treatment for shunt flow reduction. Before the procedure, blood pressures were measured at the proximal VA, distal VA near the fistula, and just at the fistula and drainer using a microcatheter. The blood pressure waveforms were characteristically different in terms of resistance index, half-decay time, and appearance of dicrotic notch. The fistula was embolized with coils and N-butyl cyanoacrylate solution. LESSONS During endovascular treatment, the authors were able to digitally record the vascular pressure waveform from the tip of the microcatheter and succeeded in calculating several parameters that characterize the shunting flow. Furthermore, these parameters could help recognize the abnormal blood flow, allowing a safer endovascular surgery.

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.

Transient rotational compression of the vertebral artery caused by herniated cervical disc

2003 ◽  
Vol 98 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Andrew N. Nemecek ◽  
David W. Newell ◽  
Robert Goodkin
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Cervical Disc ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Vertebrobasilar Ischemia ◽  
Extrinsic Compression ◽  
The Many ◽  
Herniated Cervical Disc ◽  
Adequate Decompression

✓ Of the many causes of vertebrobasilar insufficiency (VBI), extrinsic compression of the vertebral artery (VA) is relatively uncommon. A syndrome of VBI caused by extrinsic compression of the VA secondary to head rotation has been termed positional vertebrobasilar ischemia. The authors present a case of transient VBI caused by herniation of a cervical disc. Transcranial Doppler ultrasonography was used preoperatively to confirm the diagnosis and intraoperatively to monitor cerebral perfusion and to confirm that adequate decompression of the VA had been achieved.

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