Bow hunter’s syndrome revisited: 2 new cases and literature review of 124 cases

Abstract

<jats:p>Rotational occlusion of the vertebral artery (VA), or bow hunter’s syndrome, is a rare yet surgically treatable cause of vertebrobasilar insufficiency. The underlying pathology is dynamic stenosis of the VA by osteophytes, fibrous bands, or lateral disc herniation with neck rotation or extension. The authors present 2 previously unreported cases of bow hunter’s syndrome and summarize 124 cases identified in a literature review.</jats:p> <jats:p>Both patients in the new cases were treated by VA decompression and fusion of the subaxial spine. Each had &gt; 50% occlusion of the left VA at the point of entry into the transverse foramen with a contralateral VA that ended in the posterior inferior cerebellar artery. Analyzing data from 126 cases (the 2 new cases in addition to the previously published 124), the authors report that stenosis was noted within V<jats:sub>1</jats:sub> in 4% of cases, in V<jats:sub>2</jats:sub> in 58%, in V<jats:sub>3</jats:sub> in 36%, and distal to C-1 in 2%. Patients presented in the 5th to 7th decade of life and were more often male than female. The stenotic area was decompressed in 85 (73%) of the 116 patients for whom the type of treatment was reported (V<jats:sub>1</jats:sub>, 4 [80%] of 5; V<jats:sub>2</jats:sub>, 52 [83%] of 63; V<jats:sub>3</jats:sub>/V<jats:sub>4</jats:sub>, 29 [60%] of 48). Less commonly, fusion or combined decompression and fusion was used (V<jats:sub>2</jats:sub>, 7 [11%] of 63; V<jats:sub>3</jats:sub>/V<jats:sub>4</jats:sub>, 14 [29%] of 48). Most patients reported complete resolution of symptoms.</jats:p> <jats:p>The authors conclude that patients with bow hunter’s syndrome classically have an impaired collateral blood flow to the brainstem. This condition carries an excellent prognosis with decompression, fusion, or combined surgery, and individual patient characteristics should guide the choice of therapy.</jats:p>

A Subtype of Bow Hunter’s Syndrome Requiring Specific Method for Detection: A Case of Recurrent Posterior Circulation Embolism due to “Hidden Bow Hunter’s Syndrome”

“…Sufficient embolization could be achieved according It used to be considered to occur frequently at the atlantoaxial level, but a recent review of the literature suggested that the percentage of BHS involving lower cervical vertebral levels is also high. 2) In BHS, the VA is patent in the neutral position but is stenosed or occluded due to bony compression during movements. Compression often occurs when the neck is rotated to the opposite side of the lesion.…”

“…1,2) Although it is a rare condition, it must be remembered as a differential diagnosis in the evaluation of the cause of ischemia of the posterior circulation territory.…”

Advances in the Pathogenesis, Diagnosis and Treatment of Bow Hunter's Syndrome: A Comprehensive Review of the Literature

“…The percentage of males was 54.5%. Recently, Jost and Dailey [2] analyzed 126 patients diagnosed with BHS, including 2 pediatric patients, 3 adolescents and 121 adults, with a mean age of 57 ± 11 years of all the adults at diagnosis and with a male-to-female distribution of about 2:1 overall. Rastogi et al [3] reviewed 153 patients with BHS given in the literature, with a mean age of 53 years, after having excluded 10 pediatric patients (<18 years), and there were 100 males and 45 females.…”

“…The former is often caused by disc herniation [2,4], abnormal bony structures (e.g. osteophyte [7,8,9], idiopathic skeletal hyperostosis [10] and spondylotic changes [11]), ligament [4], neck muscle hypertrophy [12], VA dissection [13] and some other causes like an instability of the uncovertebral joint [14].…”

“…Jost and Dailey [2] summarized 126 cases identified in a literature review, while Rastogi et al [3] analyzed the information of 153 patients with BHS given in the literature. Moreover, due to the rarity of the pathology, there are still no guidelines on the diagnosis and management of BHS.…”