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Anterior Cervical Discectomy and Transverse Foraminotomy for Bow Hunter’s Syndrome – A Case Report a

Rishabh Jain

University of Texas Medical Branch


Introduction: Bow hunter’s syndrome describes a rare clinical entity in which lateral neck rotation results in dynamic compression of one or both vertebral arteries, often with anatomic abnormality of the contralateral vessel in cases involving compression of one artery, causing transient vertebrobasilar insufficiency. The treatment for bow hunter’s syndrome includes conservative management, but for patients with progressive or severe symptoms, more invasive interventions such as endovascular or open neurosurgical procedures may be warranted. Furthermore, in patients with severe disease, there is a risk for development of subsequent posterior cerebral circulation stroke. Here, we describe the case of a patient with bow hunter’s syndrome who underwent surgical treatment. Methods: A 58-year-old male presented with several months of progressive lightheadedness, vertigo, and fainting spells upon rotation of his head to the left. Dynamic provocative digital subtraction angiography revealed disruption of flow in the dominant left vertebral artery at the C3-4 level with ipsiversive head rotation, yet the right vertebral artery was relatively normal with patent antegrade flow through the posterior cerebral circulation. The consensus among a multidisciplinary team was that open surgery was the optimal approach. Results: The patient was positioned supine in cervical extension. An anterior cervical approach was utilized to reach the C3-4 level, and intraoperative doppler was employed to delineate the vertebral artery. An anterior cervical discectomy and fusion as well as transverse foraminotomy were then successfully performed. The patient awoke without complications with complete resolution of symptoms. Conclusion: Although bow hunter’s syndrome is a rare condition, clinical awareness of this entity and the indications for treatment is important to prevent devastating neurologic outcomes. We described here the case of a 58-year-old male with progressively worsening bow hunter’s syndrome who was successfully operated upon. In patients suffering from bow hunter’s syndrome with indications for surgical intervention, an anterior cervical discectomy and fusion with transverse foraminotomy is an appropriate option for subaxial disease.

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