A Juvenile Case of Bow Hunter's Syndrome Caused by Atlantoaxial Dislocation with Vertebral Artery Dissecting Aneurysm

Bando, Koji; Okazaki, Toshiyuki; Mure, Hideo; Korai, Masaaki; Takagi, Yasushi

doi:10.1016/j.wneu.2020.02.041

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…BHS is caused by posterior circulation insufficiency resulting from occlusion or compression of one of the VA during rotation of the head, most typically occurring at the C1-C2 level. [ 2 , 7 - 9 ] In this case, dynamic DSA and 3D-CTA were performed to document that cerebral blood flow and loss of consciousness occurred when the head was turned to the right. BHS is typically treated with C1-C2 posterior decompression of the VA and fusion.…”

Section: Discussionmentioning

confidence: 99%

“…contralateral VA hypoplasia) and can result in symptomatic infarctions of the cerebellum and/or brain stem. [ 2 , 3 , 7 ] Long-term resolution of BHS typically requires VA decompression with C1-C2 posterior instrumented (screw) fusion. [ 2 , 4 ] Notably, three-dimensional computed tomography (3D-CT) intraoperative O-arm navigation increases the safety/efficacy of posterior C1-C2 screw placement/ fusion.…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 , 3 , 7 ] Long-term resolution of BHS typically requires VA decompression with C1-C2 posterior instrumented (screw) fusion. [ 2 , 4 ] Notably, three-dimensional computed tomography (3D-CT) intraoperative O-arm navigation increases the safety/efficacy of posterior C1-C2 screw placement/ fusion. [ 10 , 11 ] Here, we present a patient with BHS successfully treated utilizing O-arm navigated with atlantoaxial decompression/screw-instrumented fusion.…”

Section: Introductionmentioning

confidence: 99%

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Utility of O-arm navigation for atlantoaxial fusion with Bow Hunter’s syndrome

Shigekawa¹,

Inoue²,

Tagawa³

et al. 2021

Surgical Neurology International

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Background: In spinal instrumentation surgery, safe and accurate placement of implants such as lateral mass screws and pedicle screws should be a top priority. In particular, C2 stabilization can be challenging due to the complex anatomy of the upper cervical spine. Here, we present a case of Bow Hunter’s syndrome (BHS) successfully treated by an O-arm-navigated atlantoaxial fusion. Case Description: A 53-year-old male presented with a 10-year history of repeated episodes of transient loss of consciousness following neck rotation to the right. Although the unenhanced magnetic resonance imaging showed no pathological findings, the MR angiogram with dynamic digital subtraction angiography revealed a dominant left vertebral artery (VA) and hypoplasia of the right VA. The latter study further demonstrated significant flow reduction in the left VA at the C1-C2 level when the head was rotated toward the right. With these findings of BHS, a C1-C2 decompression/posterior fusion using the Goel-Harms technique with O-arm navigation was performed. The postoperative cervical X-rays showed adequate decompression/fixation, and symptoms resolved without sequelae. Conclusion: C1-C2 posterior decompression/fusion effectively treats BHS, and is more safely/effectively performed utilizing O-arm navigation for C1-C2 screw placement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utility of O-arm navigation for atlantoaxial fusion with Bow Hunter’s syndrome

Shigekawa¹,

Inoue²,

Tagawa³

et al. 2021

Surgical Neurology International

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“…Reports of BHS in association with AARS are quite rare in literature, amounting to only approximately three cases or so, considering the literature evidence over the past three to four decades. 3,4 It is caused by mechanical compression of VA mostly in adults in fifth to seventh decades of life. 3 Patients present with vertigo, nystagmus, and nausea with associated emesis, and ataxia during head rotation which is relieved in neutral position.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bow Hunter's Syndrome with Rotational Atlantoaxial Instability: A Rare Association

S.,

C. Thomas,

S. Vadakkedam

et al. 2024

Asian J Neurosurg

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Bow Hunter's syndrome (BHS) is a very rare condition in which there is rotational vertebral artery (VA) insufficiency. The association of BHS with rotational atlantoaxial instability is extremely rare. We are reporting a case of pediatric BHS who presented with features of VA insufficiency on neck rotation. Careful evaluation revealed rotational C1-C2 instability. Provocative digital subtraction angiography and dynamic neck computed tomography were the mainstay of our diagnostic armamentarium. Our case emphasizes the fact that VA abnormalities need special consideration in young patients with craniovertebral junction instability and a high degree of suspicion is necessary in most instances for accurate diagnosis.

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Bow Hunter’s syndrome surgical approach and outcome: Two new cases and literature review

Elizondo-Ramirez,

Herrera-Castro,

del Rio-Martinez

et al. 2024

Surgical Neurology International

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Background: Bow Hunter’s syndrome (BHS) is a rare entity known as rotational vertebral artery occlusion syndrome. Classically, it presents with nausea, vertigo, and dizziness elicited by extension or rotation of the neck. There are several management approach modalities, including surgical and nonsurgical alternatives. Methods: We conducted an electronic database search on PubMed and Scopus. The search was performed on February 18, 2024, using a combination of keywords related to Bow Hunter Syndrome regarding management. From the latter query, 97 results followed, from which we included 76 and excluded 21 due to the information being irrelevant to our study and non-retrievable publications. Results: A total of 121 patients were retrieved. The mean age of presentation was 50 years, with a female-to-male ratio of 3:1. There were 108 adult cases, and only 13 were pediatric and adolescents. Symptoms were elicited by right rotation (46%). The most affected levels were C1-C2 (44%). The anterior approach was the most common (40%) and had a better outcome (84%), followed by the posterior (30%), which had more cases with partial recovery (19% vs. 16%). Conclusion: BHS management is still challenging as there are many factors that we must consider when deciding on the approach. There is inconclusive evidence on the proper management of these patients. Although the suggestions found in our review and our experience are valuable, no definitive management ensures a good quality of life and outcome for these patients. Further research is needed on this topic.

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A Juvenile Case of Bow Hunter's Syndrome Caused by Atlantoaxial Dislocation with Vertebral Artery Dissecting Aneurysm

Cited by 5 publications

References 11 publications

Utility of O-arm navigation for atlantoaxial fusion with Bow Hunter’s syndrome

Utility of O-arm navigation for atlantoaxial fusion with Bow Hunter’s syndrome

Bow Hunter's Syndrome with Rotational Atlantoaxial Instability: A Rare Association

Bow Hunter’s syndrome surgical approach and outcome: Two new cases and literature review

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