Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
World Neurosurg. 2012 Nov;78(5):553.e15-7. doi: 10.1016/j.wneu.2011.09.050. Epub 2011 Nov 1.
Bow hunter's syndrome is a rare cause of vertebrobasilar insufficiency arising from mechanical compression of the vertebral artery (VA) during rotation of the head. Surgical treatment usually involves direct decompression of the VA at the site of compression. We describe what is to our knowledge the first reported case of a posterior inferior cerebellar artery (PICA)-to-PICA in situ bypass for treatment of Bow hunter's-type ischemia in a patient with a VA dissection.
The patient was a 41-year-old man who developed disabling symptoms of vertebrobasilar insufficiency after trauma when he rotated his head to the right. Dynamic angiography demonstrated a chronic dissection and stasis of flow in the right VA when his head was rotated to the right, with no obvious site of focal compression. The right VA ended in the PICA and the left VA was of good caliber. A single-photon emission computed tomography study with acetazolamide challenge confirmed brainstem ischemia and poor cerebrovascular reserve. He ultimately underwent a PICA-to-PICA in situ bypass to revascularize his right PICA territory with complete symptom resolution.
The PICA-to-PICA in situ bypass is a useful option in the treatment of Bow hunter's-type ischemia in the absence of focal structural compression of the VA or VA stenosis.
弓型Hunter 综合征是一种罕见的因椎动脉（VA）在头部旋转过程中受到机械性压迫而导致椎基底动脉供血不足的疾病。手术治疗通常涉及在受压部位直接对 VA 进行减压。我们描述了首例据我们所知的在后下小脑动脉（PICA）原位旁路治疗 VA 夹层弓型 Hunter 型缺血的病例。
患者为 41 岁男性，在头部右转时因外伤出现椎基底动脉供血不足的致残性症状。动态血管造影显示，当头部向右转时，右侧 VA 慢性夹层和血流停滞，没有明显的局灶性压迫部位。右侧 VA 止于 PICA，左侧 VA 口径良好。乙酰唑胺挑战单光子发射计算机断层扫描研究证实存在脑干缺血和脑血流量储备不足。最终，他接受了 PICA 到 PICA 的原位旁路手术，以改善右侧 PICA 区域的血供，症状完全缓解。
在不存在 VA 局灶性结构压迫或 VA 狭窄的情况下，PICA 到 PICA 原位旁路是治疗弓型 Hunter 型缺血的一种有效选择。
