Compression Syndromes of the Vertebral Artery at the Craniocervical Junction

  • Jan Frederick CorneliusEmail author
  • Raoul Pop
  • Marco Fricia
  • Bernard George
  • Salvatore Chibbaro
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)


Compression syndromes of the vertebral artery that occur at the craniocervical junction are extremely rare causes of haemodynamic insufficiency of the posterior cerebral circulation. The aetiology of the compression syndrome may be a malformation, trauma, tumour, infection or degenerative pathology. This may lead to dynamic vertebral artery occlusion where the vessel courses around the atlas and the axis—the so-called V3 segment. This in turn may result in insufficient collateral flow to the posterior fossa. The clinical picture is a vertebrobasilar insufficiency syndrome of variable expression ranging from vertigo to posterior fossa stroke. The typical clinical presentation is syncope occurring during rotation of the head, also known as ‘bow hunter’s syndrome’. The workup is based on dynamic angiography and computed tomography angiography. The treatment of choice is surgical vascular decompression, resulting in a good clinical outcome. However, in some instances, atlantoaxial fusion may be indicated. Alternatively, conservative and endovascular options have to be considered in inoperable patients.


Bow hunter’s syndrome Extrinsic compression of the vertebral artery Craniocervical junction Surgical management Vertebrobasilar insufficiency and stroke 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Jan Frederick Cornelius
    • 1
    Email author
  • Raoul Pop
    • 2
  • Marco Fricia
    • 3
  • Bernard George
    • 4
  • Salvatore Chibbaro
    • 5
  1. 1.Neurochirurgische Klinik, UniversitätsklinikumDusseldorfGermany
  2. 2.Service de neuroradiologie interventionnelleCHUStrasbourgFrance
  3. 3.Neurosurgery DepartmentCannizzaro HospitalCataniaItaly
  4. 4.Service de neurochirurgieCHU LariboisiereParisFrance
  5. 5.Service de neurochirurgieCHUStrasbourgFrance

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