Neurosurgical Review

, Volume 35, Issue 1, pp 127–135 | Cite as

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

  • Jan Frederick Cornelius
  • Bernard George
  • Dominique N’dri Oka
  • Toma Spiriev
  • Hans Jakob Steiger
  • Daniel Hänggi
Original Article


Bow hunter's syndrome (BHS) is defined as symptomatic, vertebro-basilar insufficiency caused by mechanical occlusion of the vertebral artery (VA) at the atlanto-axial level during head rotation. In the literature, about 40 cases have been reported. However, due to the rarity of this pathology, there are no guidelines for diagnosis and treatment. Conservative, surgical, and endovascular concepts have been proposed. In order to work out an algorithm, we performed a systematic review of the literature and a retrospective analysis of patients, which have been treated in our institutions over the last decade. The clinical series was comprised of five patients. The symptoms ranged from transient vertigo to posterior circulation stroke. Diagnosis was established by dynamic angiography. In all patients, the VA was decompressed; one patient required additional fusion. The clinical and radiological results were good, and the treatment-related morbidity was low. The literature review demonstrated that Bow hunter's syndrome is a rare pathology but associated with a pathognomonic and serious clinical presentation. The gold standard of diagnosis is dynamic angiography, and patients were well managed with tailored vertebral artery decompression. By this management, clinical and radiological results were excellent and the treatment-related morbidity was low.


Bow hunter's syndrome Cranio-cervical junction Extrinsic vertebral artery compression Vertebro-basilar insufficiency Surgery Therapy 


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Jan Frederick Cornelius
    • 1
    • 2
    • 4
  • Bernard George
    • 1
  • Dominique N’dri Oka
    • 1
  • Toma Spiriev
    • 1
    • 3
  • Hans Jakob Steiger
    • 2
  • Daniel Hänggi
    • 2
  1. 1.Service de Neurochirurgie, Hôpital LariboisièreUniversité Paris VIIParisFrance
  2. 2.Klinik für Neurochirurgie, Universitätsklinikum DüsseldorfHeinrich-Heine-UniversityDüsseldorfGermany
  3. 3.Departement of NeurosurgeryTokuda HospitalSofiaBulgaria
  4. 4.Neurochirurgische KlinikUniversitätsklinik DüsseldorfDüsseldorfGermany

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