Bow Hunter Syndrome with Associated Pseudoaneurysm.

Aneurysm, False / complications Cervical Vertebrae / diagnostic imaging Female Humans Middle Aged Spinal Fusion Vertebral Artery Vertebrobasilar Insufficiency / complications
Bow hunter syndrome Case report Pseudoaneurysm Rotational vertebral artery occlusion

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
Feb 2019
Historique:
received: 13 08 2018
revised: 14 10 2018
accepted: 16 10 2018
pubmed: 23 11 2018
medline: 8 3 2019
entrez: 23 11 2018
Statut: ppublish

Résumé

Bow hunter syndrome describes a mechanical compression of the vertebral artery on head rotation leading to reversible symptomatic vertebrobasilar insufficiency. Patients are commonly presenting with syncope, vertigo, dizziness, and visual disturbances. These symptoms usually resolve when the head is turned back into neutral position. Treatment options involve surgical decompression with or without fusion, bypass surgery, or endovascular intervention. We report about a 49-year-old female who presented with vague neck pain and severe vertigo, nausea, and near syncope when her head turned up and right. Computed tomography angiography revealed a pseudoaneurysm at the dominant left V3 and near total occlusion of the left vertebral artery as it exited the C2 foramen when the head was turned to the previously mentioned position. The patient could be successfully treated by computed tomography-navigated posterior instrumentation using bilateral C1 lateral mass screws and C2 translaminar screws. To promote segmental fusion, bilateral intrafacet cages were implanted. Postoperatively, the patient remained without neurologic deficits and experienced no further episodes of the preoperatively reported transient vertebrobasilar insufficiency symptoms. The reported case is unique as the bow hunter syndrome was further complicated by a pseudoaneurysm of the V3 segment. Surgical intervention proved to be an efficient treatment by stabilizing the affected segment in this patient.

Sections du résumé

BACKGROUND BACKGROUND
Bow hunter syndrome describes a mechanical compression of the vertebral artery on head rotation leading to reversible symptomatic vertebrobasilar insufficiency. Patients are commonly presenting with syncope, vertigo, dizziness, and visual disturbances. These symptoms usually resolve when the head is turned back into neutral position. Treatment options involve surgical decompression with or without fusion, bypass surgery, or endovascular intervention.
CASE DESCRIPTION METHODS
We report about a 49-year-old female who presented with vague neck pain and severe vertigo, nausea, and near syncope when her head turned up and right. Computed tomography angiography revealed a pseudoaneurysm at the dominant left V3 and near total occlusion of the left vertebral artery as it exited the C2 foramen when the head was turned to the previously mentioned position. The patient could be successfully treated by computed tomography-navigated posterior instrumentation using bilateral C1 lateral mass screws and C2 translaminar screws. To promote segmental fusion, bilateral intrafacet cages were implanted. Postoperatively, the patient remained without neurologic deficits and experienced no further episodes of the preoperatively reported transient vertebrobasilar insufficiency symptoms.
CONCLUSIONS CONCLUSIONS
The reported case is unique as the bow hunter syndrome was further complicated by a pseudoaneurysm of the V3 segment. Surgical intervention proved to be an efficient treatment by stabilizing the affected segment in this patient.

Identifiants

DOI: 10.1016/j.wneu.2018.10.102 PMID: 30463807
pubmed: 30463807
pii: S1878-8750(18)32400-8
doi: 10.1016/j.wneu.2018.10.102
pii:
doi:

Types de publication

Case Reports Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

53-57

Informations de copyright

Copyright © 2018 Elsevier Inc. All rights reserved.

Auteurs

R Nick Hernandez (RN)

Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.

Christoph Wipplinger (C)

Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA. Electronic address: chw2035@med.cornell.edu.

Rodrigo Navarro-Ramirez (R)

Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.

Athos Patsalides (A)

Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.

Apostolos John Tsiouris (AJ)

Department of Neuroradiology, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.

Philip E Stieg (PE)

Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.

Sertac Kirnaz (S)

Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.

Franziska Anna Schmidt (FA)

Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.

Roger Härtl (R)

Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.

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Classifications MeSH

questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Faux anévrisme › Bow Hunter Syndrome with Associated Pseudoaneurysm.
questionsmedicales.fr › Appareil locomoteur › Squelette › Rachis › Vertèbres cervicales › Bow Hunter Syndrome with Associated Pseudoaneurysm.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Bow Hunter Syndrome with Associated Pseudoaneurysm.
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Bow Hunter Syndrome with Associated Pseudoaneurysm.
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures orthopédiques › Arthrodèse › Arthrodèse vertébrale › Bow Hunter Syndrome with Associated Pseudoaneurysm.
questionsmedicales.fr › Système cardiovasculaire › Vaisseaux sanguins › Artères › Artère vertébrale › Bow Hunter Syndrome with Associated Pseudoaneurysm.
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Insuffisance vertébrobasilaire › Bow Hunter Syndrome with Associated Pseudoaneurysm.