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2015 ; 6
(ä): 147
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Surgical decompression coupled with diagnostic dynamic intraoperative angiography
for bow hunter s syndrome
#MMPMID26487972
Nguyen HS
; Doan N
; Eckardt G
; Pollock G
Surg Neurol Int
2015[]; 6
(ä): 147
PMID26487972
show ga
BACKGROUND: Bow hunter's syndrome, also known as rotational vertebrobasilar
insufficiency, arises from mechanical compression of the vertebral artery during
the neck rotation. Surgical options have been the mainstay treatment of choice.
Postoperative imaging is typically used to assess adequate decompression. On the
other hand, intraoperative assessment of decompression has been rarely reported.
CASE DESCRIPTION: A 52-year-old male began to see "black spots," and experienced
presyncope whenever he rotated his head toward the right. The patient ultimately
underwent a dynamic diagnostic cerebral angiogram, which revealed a dominant
right vertebral artery and complete proximal occlusion of the right vertebral
artery with the head rotated toward the right. Subsequently, the patient
underwent an anterior transcervical approach to the right C6/C7 transverse
process. The bone removal occurred along with the anterior wall of the C6 foramen
transversarium, followed by the upper portion of the anterior C6 body medially,
and the transverse process of C6 laterally. An oblique osseofibrous band was
noted to extend across the vertebral artery; it was dissected and severed. An
intraoperative cerebral angiogram confirmed no existing compression of the
vertebral artery with the head rotated toward the right. The patient recovered
from surgery without issues; he denied recurrence of preoperative symptoms at
follow-up. CONCLUSIONS: The authors report the third instance where
intraoperative dynamic angiography was employed with good outcomes. Although
intraoperative cerebral angiography is an invasive procedure, which prompts
additional risks, the authors believe the modality affords better, real-time
visualization of the vertebral artery, allowing for assessment of the adequacy of
the decompression. This advantage may reduce the probability for a second
procedure, which has its own set of risks, and may counteract the risks involved
with intraoperative dynamic angiography.