• Sam Ng, Julien Boetto, Valentin Favier, Eric Thouvenot, Vincent Costalat, and Nicolas Lonjon.
• Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France. Electronic address: s-ng@chu-montpellier.fr.
• World Neurosurg. 2018 Oct 1; 118: 290-295.

BackgroundBow hunter's syndrome is a symptomatic vertebrobasilar insufficiency resulting from a rotational stenosis or occlusion of a dominant vertebral artery (VA). The VA is dynamically compressed by cervical osteoarthritis (discovertebral structure or osteophytes) during head rotation or neck extension. Diagnosis is based on dynamic computed tomography angiography and confirmed with dynamic catheter angiography. Surgery tends to be the best treatment option in most cases. Dynamic intraoperative assessment of VA decompression seems to improve surgical results but remains poorly evaluated in the literature.Case DescriptionA 70-year-old man with bow hunter's syndrome related to left VA compression by C3-4 osteophyte protrusion presented with syncopal episodes during left head rotation. Bow hunter's syndrome was successfully managed with an anterior transuncal surgical decompression of the left VA and C3-4 fusion. Surgical decompression was guided by dynamic intraoperative catheter angiography and secured with an intra-arterial remodeling balloon placed just before surgery. The patient was symptom-free after surgery.ConclusionsSurgical decompression guided by dynamic intraoperative catheter angiography leads to selective VA release and allows real-time assessment of the efficacy of the decompression. This multidisciplinary treatment involving neurosurgical and neuroradiologic teams is a simple and effective treatment. Dynamic intraoperative catheter angiography is an essential guide to perform selective decompression of the VA, and implementation of an intra-arterial remodeling balloon can improve the safety of surgery making this method valuable compared with other intraoperative assessment techniques, such as Doppler ultrasound and indocyanine green fluorescent videography.Copyright © 2018 Elsevier Inc. All rights reserved.

25 keywords...

hide…