Use of Microscope-integrated Near-infrared Indocyanine Green Videoangiography in Surgical Treatment of a Case of Bow Hunter's Syndrome

Abstract

Bow hunter's syndrome, also known as rotational vertebral artery occlusion, is characterized by recurrent attacks of paroxysmal vertigo, nystagmus, and syncope induced by horizontal head rotation. Typically, rotation of the head may induce stenosis or occlusion of the vertebral artery in C1 2 level, leading to compromised blood flow in the territory of the vertebro basilar artery. We report a rare case of bow hunter's syndrome, in which compression of the vertebral artery was evident at the C6 level where the dominant vertebral artery enters the C6 transverse foramen. We utilized an anterolateral approach to reach the anterior wall of the C6 transverse foramen and successfully decompressed the vertebral artery. Importantly, intraoperative indocyanine green ICG videoangiography provided real time information regarding the patency of the vessel after surgical manipulation. Thus, it was useful for spine surgeons to confirm degree of decompression of the vertebral artery. This is one of the first reports of the application of ICG videoangiography during surgical treatment of bow hunter's syndrome.