Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2014 Nov;82(5):733-8. doi: 10.1016/j.wneu.2014.02.027. Epub 2014 Feb 16.
Bow hunter's syndrome is a rare vascular phenomenon characterized by insufficiency of the posterior cerebral circulation induced by rotation of the head within normal physiologic range. The neurosurgical literature on evidence-based diagnosis and management of the disease is scarce, and reports are largely limited to case studies.
A retrospective chart review was performed on all patients referred to Barrow Neurological Institute during the period 1999-2013 with signs and symptoms that were possibly indicative of bow hunter's syndrome. Demographic data from patient charts were collected, and the patients' imaging studies were reviewed.
There were 14 patients referred to Barrow Neurological Institute with symptoms concerning for bow hunter's syndrome, and 11 of these patients were confirmed to have dynamic vertebral artery compression on angiography. The location of compression was centered on C1-2 (50%) or C5-7 (50%). The compressed vertebral artery was typically the left artery (72.7%), and in 54.5% of cases, rotation of the head to the contralateral side produced symptomatic dynamic compression. Surgical decompression, via either an anterior (44.4%) or a posterior (55.6%) approach, was eventually performed in 9 patients. Decompression alone was performed in all cases; however, 1 patient developed cervical instability requiring an anterior cervical instrumented fusion 5 years later.
Decompression without fusion is a safe, reliable surgical option in patients with bow hunter's syndrome. Decompression is performed via a posterior approach for atlantoaxial vertebral artery compression and via an anterior approach for subaxial compression. Long-term complications include cervical instability, which may necessitate internal fixation and fusion.
弓型Hunter 综合征是一种罕见的血管现象，其特征是在正常生理范围内头部旋转引起的后循环不足。神经外科学文献中关于该疾病的循证诊断和治疗的证据很少，并且报告主要限于病例研究。
对 1999 年至 2013 年期间因可能有弓型 Hunter 综合征症状而转诊至巴罗神经学研究所的所有患者进行回顾性图表审查。从患者图表中收集人口统计学数据，并对患者的影像学研究进行了回顾。
有 14 名患者因可能有弓型 Hunter 综合征症状而转诊至巴罗神经学研究所，其中 11 名患者在血管造影中证实存在椎动脉动态压迫。压迫的位置集中在 C1-2（50%）或 C5-7（50%）。受压的椎动脉通常是左侧动脉（72.7%），在 54.5%的情况下，向对侧旋转头部会产生有症状的动态压迫。9 名患者最终通过前路（44.4%）或后路（55.6%）进行了减压手术。所有病例均仅行减压术；然而，1 例患者 5 年后因颈椎不稳定需要前路颈椎器械融合。
对于弓型 Hunter 综合征患者，减压而不融合是一种安全可靠的手术选择。后路用于寰枢椎椎动脉压迫，前路用于下位颈椎压迫。长期并发症包括颈椎不稳定，可能需要内固定和融合。
