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

Abstract

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.

Keywords

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

References

  1. 1.
    Akar Z, Kafadar AM, Tanriover N, Dashti RS, Islak C, Kocer N, Kuday C (2000) Rotational compression of the vertebral artery at the point of dural penetration. Case report. J Neurosurg 93(2 Suppl):300–303PubMedGoogle Scholar
  2. 2.
    Bakay L, Leslie EV (1965) Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis. J Neurosurg 23(6):596–602. doi:10.3171/jns.1965.23.6.0596 PubMedCrossRefGoogle Scholar
  3. 3.
    Barton JW, Margolis MT (1975) Rotational obstructions of the vertebral artery at the atlantoaxial joint. Neuroradiology 9(3):117–120PubMedCrossRefGoogle Scholar
  4. 4.
    Bauer R, Sheehan S, Meyer JS (1961) Arteriographic study of cerebrovascular disease. II. Cerebral symptoms due to kinking, tortuosity, and compression of carotid and vertebral arteries in the neck. Arch Neurol 4:119–131PubMedCrossRefGoogle Scholar
  5. 5.
    Bruneau M, Cornelius JF, George B (2006) Antero-lateral approach to the V3 segment of the vertebral artery. Neurosurgery 58(1 Suppl):ONS29–ONS35, discussion ONS29-35PubMedGoogle Scholar
  6. 6.
    Bruneau M, Sauvageau E, Nakaji P, Vandesteene A, Lubicz B, Chang SW, Baleriaux D, Brotchi J, De Witte O, Spetzler RF (2010) Preliminary personal experiences with the application of near-infrared indocyanine green videoangiography in extracranial vertebral artery surgery. Neurosurgery 66(2):305–311, discussion 311PubMedCrossRefGoogle Scholar
  7. 7.
    Brunon J, Goutelle A (1974) Surgical treatment of vertebro-basilar insufficiency caused by extrinsic compression of the extracranial vertebral artery. Neurochirurgie 20(2):125–145PubMedGoogle Scholar
  8. 8.
    Bulsara KR, Velez DA, Villavicencio A (2006) Rotational vertebral artery insufficiency resulting from cervical spondylosis: case report and review of the literature. Surg Neurol 65(6):625–627PubMedCrossRefGoogle Scholar
  9. 9.
    Chough CK, Cheng BC, Welch WC, Park CK (2010) Bow hunter's stroke caused by a severe facet hypertrophy of C1–2. J Korean Neurosurg Soc 47(2):134–136PubMedCrossRefGoogle Scholar
  10. 10.
    Ford FR (1952) Syncope, vertigo and disturbances of vision resulting from intermittent obstruction of the vertebral arteries due to defect in the odontoid process and excessive mobility of the second cervical vertebra. Bull Johns Hopkins Hosp 91(3):168–173PubMedGoogle Scholar
  11. 11.
    Fox MW, Piepgras DG, Bartleson JD (1995) Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery. Case report. J Neurosurg 83(4):737–740Google Scholar
  12. 12.
    George B (1993) Surgical treatment of extrinsic and neoplastic vertebral artery compression. Bull Acad Natl Med 177(1):99–111, discussion 111–112PubMedGoogle Scholar
  13. 13.
    George B, Carpentier A (2001) Compression of and by the vertebral artery. Oper Tech Neurosurg 4(4):202–218CrossRefGoogle Scholar
  14. 14.
    George B, Cornelius JF (2001) Vertebral artery: surgical anatomy. Oper Tech Neurosurg 4(4):168–181CrossRefGoogle Scholar
  15. 15.
    George B, Laurian C (1979) Surgical possibilities in the third portion of the vertebral artery (above C2). Anatomical study and report of a case of anastomosis between subclavian artery and vertebral artery at C1–C2 level. Acta Neurochir Suppl (Wien) 28(1):263–269Google Scholar
  16. 16.
    George B, Laurian C (1980) Surgical approach to the whole length of the vertebral artery with special reference to the third portion. Acta Neurochir (Wien) 51(3–4):259–272CrossRefGoogle Scholar
  17. 17.
    George B, Laurian C (1989) Impairment of vertebral artery flow caused by extrinsic lesions. Neurosurgery 24(2):206–214PubMedCrossRefGoogle Scholar
  18. 18.
    Grossmann RI, Davis KR (1982) Positional occlusion of the vertebral artery: a rare cause of embolic stroke. Neuroradiology 23(4):227–230PubMedCrossRefGoogle Scholar
  19. 19.
    Hanakita J, Miyake H, Nagayasu S, Nishi S, Suzuki T (1988) Angiographic examination and surgical treatment of Bow hunter's stroke. Neurosurgery 23(2):228–232PubMedCrossRefGoogle Scholar
  20. 20.
    Hardin CA, Poser CM (1963) Rotational obstruction of the vertebral artery due to redundancy and extraluminal cervical fascial bands. Ann Surg 158:133–137PubMedCrossRefGoogle Scholar
  21. 21.
    Hardin CA, Williamson WP, Steegmann AT (1960) Vertebral artery insufficiency produced by cervical osteoarthritic spurs. Neurology 10:855–858PubMedGoogle Scholar
  22. 22.
    Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26(22):2467–2471CrossRefGoogle Scholar
  23. 23.
    Horowitz M, Jovin T, Balzar J, Welch W, Kassam A (2002) Bow hunter's syndrome in the setting of contralateral vertebral artery stenosis: evaluation and treatment options. Spine (Phila Pa 1976) 27(23):E495–E498CrossRefGoogle Scholar
  24. 24.
    Iguchi Y, Kimura K, Shibazaki K, Iwanaga T, Ueno Y, Inoue T (2006) Transcranial doppler and carotid duplex ultrasonography findings in Bow hunter's syndrome. J Neuroimaging 16(3):278–280PubMedCrossRefGoogle Scholar
  25. 25.
    Kimura T, Sako K, Tohyama Y, Hodozuka A (1999) Bow Hunter's stroke caused by simultaneous occlusion of both vertebral arteries. Acta Neurochir (Wien) 141(8):895–896CrossRefGoogle Scholar
  26. 26.
    Kuether TA, Nesbit GM, Clark WM, Barnwell SL (1997) Rotational vertebral artery occlusion: a mechanism of vertebrobasilar insufficiency. Neurosurgery 41(2):427–432, discussion 432–423PubMedCrossRefGoogle Scholar
  27. 27.
    Lemole GM HJ, Spetzler RF, Zabramski JM. (2001) Bow hunter’s stroke. BNI Quaterly 2001 17:4–10Google Scholar
  28. 28.
    Mapstone T, Spetzler RF (1982) Vertebrobasilar insufficiency secondary to vertebral artery occlusion froma fibrous band. Case report. J Neurosurg 56(4):581–583PubMedCrossRefGoogle Scholar
  29. 29.
    Matsuyama T, Morimoto T, Sakaki T (1997) Bow Hunter's stroke caused by a nondominant vertebral artery occlusion: case report. Neurosurgery 41(6):1393–1395PubMedCrossRefGoogle Scholar
  30. 30.
    Matsuyama T, Morimoto T, Sakaki T (1997) Comparison of C1–2 posterior fusion and decompression of the vertebral artery in the treatment of bow hunter's stroke. J Neurosurg 86(4):619–623PubMedCrossRefGoogle Scholar
  31. 31.
    Matsuyama T, Morimoto T, Sakaki T (1997) Usefulness of three-dimensional CT for bow hunter stroke. Acta Neurochir (Wien) 139(3):265–266CrossRefGoogle Scholar
  32. 32.
    Miele VJ, France JC, Rosen CL (2008) Subaxial positional vertebral artery occlusion corrected by decompression and fusion. Spine (Phila Pa 1976) 33(11):E366–E370CrossRefGoogle Scholar
  33. 33.
    Netuka D, Benes V, Mikulik R, Kuba R (2005) Symptomatic rotational occlusion of the vertebral artery—case report and review of the literature. Zentralbl Neurochir 66(4):217–222PubMedCrossRefGoogle Scholar
  34. 34.
    Puca A, Scogna A, Rollo M (2000) Craniovertebral junction malformation and rotational occlusion of the vertebral artery. Br J Neurosurg 14(4):361–364PubMedCrossRefGoogle Scholar
  35. 35.
    Seki T, Hida K, Akino M, Iwasaki Y (2001) Anterior decompression of the atlantoaxial vertebral artery to treat bow hunter's stroke: technical case report. Neurosurgery 49(6):1474–1476Google Scholar
  36. 36.
    Shimizu S, Yamada M, Takagi H, Fujii K, Kan S (1999) Bow hunter's stroke associated with an aberrant course of the vertebral artery—case report. Neurol Med Chir (Tokyo) 39(12):867–869CrossRefGoogle Scholar
  37. 37.
    Shimizu T, Waga S, Kojima T, Niwa S (1988) Decompression of the vertebral artery for Bow-hunter's stroke. Case report. J Neurosurg 69(1):127–131PubMedCrossRefGoogle Scholar
  38. 38.
    Sorensen BF (1978) Bow hunter's stroke. Neurosurgery 2(3):259–261PubMedCrossRefGoogle Scholar
  39. 39.
    Sugiu K, Agari T, Tokunaga K, Nishida A, Date I (2009) Endovascular treatment for bow hunter's syndrome: case report. Minim Invasive Neurosurg 52(4):193–195PubMedCrossRefGoogle Scholar
  40. 40.
    Tominaga T, Takahashi T, Shimizu H, Yoshimoto T (2002) Rotational vertebral artery occlusion from occipital bone anomaly: a rare cause of embolic stroke. Case report. J Neurosurg 97(6):1456–1459PubMedCrossRefGoogle Scholar
  41. 41.
    Velat GJ, Reavey-Cantwell JF, Ulm AJ, Lewis SB (2006) Intraoperative dynamic angiography to detect resolution of Bow Hunter's syndrome: technical case report. Surg Neurol 66(4):420–423, discussion 423PubMedCrossRefGoogle Scholar
  42. 42.
    Vilela MD, Goodkin R, Lundin DA, Newell DW (2005) Rotational vertebrobasilar ischemia: hemodynamic assessment and surgical treatment. Neurosurgery 56(1):36–43, discussion 43–35PubMedGoogle Scholar
  43. 43.
    Wakayama K, Murakami M, Suzuki M, Ono S, Shimizu N (2005) Ischemic symptoms induced by occlusion of the unilateral vertebral artery with head rotation together with contralateral vertebral artery dissection—case report. J Neurol Sci 236(1–2):87–90PubMedCrossRefGoogle Scholar
  44. 44.
    Wang S, Wang C, Liu Y, Yan M, Zhou H (2009) Anomalous vertebral artery in craniovertebral junction with occipitalization of the atlas. Spine (Phila Pa 1976) 34(26):2838–2842CrossRefGoogle Scholar
  45. 45.
    Yang PJ, Latack JT, Gabrielsen TO, Knake JE, Gebarski SS, Chandler WF (1985) Rotational vertebral artery occlusion at C1–C2. AJNR Am J Neuroradiol 6(1):96–100PubMedGoogle Scholar

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

Personalised recommendations