Bow Hunter's Syndrome Caused by Compression of the Subaxial Vertebral Artery: Surgical Technique of Anterolateral Decompression (video). 2018

Jan Frederick Cornelius, and Philipp J Slotty, and Angelo Tortora, and Athanasios K Petridis, and Hans J Steiger, and Bernard George
Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany. Electronic address: cornelius@hhu.de.

Bow hunter's syndrome is a rare clinical condition. It is caused by dynamic compression of the vertebral artery (VA) either at the level of the transverse foramina (V2 segment) or at the atlantoaxial level (V3 segment). We report a 54-year-old man with typical bow hunter's syndrome caused by compression at the level of C6/C7. He was successfully treated by anterolateral VA decompression without a need for stabilization. We present preoperative imaging (magnetic resonance imaging, computed tomographic angiography, and dynamic angiography) and a high-quality intraoperative video detailing each step of the surgical technique (high-definition video with annotations and audio track of the Doppler ultrasound used as intraoperative control). Furthermore, postoperative imaging and a video of the clinical outcome are presented. Adequate management of bow hunter's syndrome requires good pathophysiologic understanding of the disease and careful clinical examination. Dynamic angiography confirms the exact site of VA compression. Surgical decompression is the treatment of the cause. Surgical techniques include VA decompression by an anterolateral approach (V2 or V3) or a posterior approach (V3). Some authors advocate stand-alone stabilization, which is, however, only an indirect treatment and results in significant loss of head motion. Other nonsurgical treatments such as orthesis, medical therapy, or endovascular stenting have been only anecdotally reported. Bow hunter's syndrome is best treated by VA decompression. This may safely be achieved by good anatomic knowledge and a straightforward surgical technique. Here, the anterolateral approach is presented in detail in a high-definition surgical instruction video.

UI MeSH Term Description Entries
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000072226 Computed Tomography Angiography A non-invasive method that uses a CT scanner for capturing images of blood vessels and tissues. A CONTRAST MATERIAL is injected, which helps produce detailed images that aid in diagnosing VASCULAR DISEASES. Angiography, CT,Angiography, Computed Tomography,CT Angiography,Angiographies, CT,Angiographies, Computed Tomography,CT Angiographies,Computed Tomography Angiographies,Tomography Angiographies, Computed,Tomography Angiography, Computed
D014711 Vertebral Artery The first branch of the SUBCLAVIAN ARTERY with distribution to muscles of the NECK; VERTEBRAE; SPINAL CORD; CEREBELLUM; and interior of the CEREBRUM. Vertebral Arteries,Arteries, Vertebral,Artery, Vertebral
D014715 Vertebrobasilar Insufficiency Localized or diffuse reduction in blood flow through the vertebrobasilar arterial system, which supplies the BRAIN STEM; CEREBELLUM; OCCIPITAL LOBE; medial TEMPORAL LOBE; and THALAMUS. Characteristic clinical features include SYNCOPE; lightheadedness; visual disturbances; and VERTIGO. BRAIN STEM INFARCTIONS or other BRAIN INFARCTION may be associated. Basilar Artery Insufficiency,Basilar Artery Stenosis,Vertebral Artery Insufficiency,Vertebral Artery Stenosis,Basilar Artery Ischemia,Basilar Insufficiency,Vertebral Artery Ischemia,Vertebro-Basilar Insufficiency,Vertebro-Basilar Ischemia,Vertebrobasilar Dolichoectasia,Vertebrobasilar Ischemia,Artery Insufficiencies, Basilar,Artery Insufficiencies, Vertebral,Artery Insufficiency, Basilar,Artery Insufficiency, Vertebral,Artery Ischemia, Basilar,Artery Ischemia, Vertebral,Artery Ischemias, Basilar,Artery Ischemias, Vertebral,Artery Stenoses, Basilar,Artery Stenoses, Vertebral,Artery Stenosis, Basilar,Artery Stenosis, Vertebral,Basilar Artery Insufficiencies,Basilar Artery Ischemias,Basilar Artery Stenoses,Basilar Insufficiencies,Dolichoectasia, Vertebrobasilar,Dolichoectasias, Vertebrobasilar,Insufficiencies, Basilar,Insufficiencies, Basilar Artery,Insufficiencies, Vertebral Artery,Insufficiencies, Vertebro-Basilar,Insufficiencies, Vertebrobasilar,Insufficiency, Basilar,Insufficiency, Basilar Artery,Insufficiency, Vertebral Artery,Insufficiency, Vertebro-Basilar,Insufficiency, Vertebrobasilar,Ischemia, Basilar Artery,Ischemia, Vertebral Artery,Ischemia, Vertebro-Basilar,Ischemia, Vertebrobasilar,Ischemias, Basilar Artery,Ischemias, Vertebral Artery,Ischemias, Vertebro-Basilar,Ischemias, Vertebrobasilar,Stenoses, Basilar Artery,Stenoses, Vertebral Artery,Stenosis, Basilar Artery,Stenosis, Vertebral Artery,Vertebral Artery Insufficiencies,Vertebral Artery Ischemias,Vertebral Artery Stenoses,Vertebro Basilar Insufficiency,Vertebro Basilar Ischemia,Vertebro-Basilar Insufficiencies,Vertebro-Basilar Ischemias,Vertebrobasilar Dolichoectasias,Vertebrobasilar Insufficiencies,Vertebrobasilar Ischemias
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D019299 Decompression, Surgical A surgical operation for the relief of pressure in a body compartment or on a body part. (From Dorland, 28th ed) Surgical Decompression,Decompressions, Surgical,Surgical Decompressions

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