Jost Gregory F, Dailey Andrew T
Spine Surgery, University Hospital Basel, Switzerland; and.
Neurosurg Focus. 2015 Apr;38(4):E7. doi: 10.3171/2015.1.FOCUS14791.
Rotational occlusion of the vertebral artery (VA), or bow hunter's syndrome, is a rare yet surgically treatable cause of vertebrobasilar insufficiency. The underlying pathology is dynamic stenosis of the VA by osteophytes, fibrous bands, or lateral disc herniation with neck rotation or extension. The authors present 2 previously unreported cases of bow hunter's syndrome and summarize 124 cases identified in a literature review. Both patients in the new cases were treated by VA decompression and fusion of the subaxial spine. Each had > 50% occlusion of the left VA at the point of entry into the transverse foramen with a contralateral VA that ended in the posterior inferior cerebellar artery. Analyzing data from 126 cases (the 2 new cases in addition to the previously published 124), the authors report that stenosis was noted within V1 in 4% of cases, in V2 in 58%, in V3 in 36%, and distal to C-1 in 2%. Patients presented in the 5th to 7th decade of life and were more often male than female. The stenotic area was decompressed in 85 (73%) of the 116 patients for whom the type of treatment was reported (V1, 4 [80%] of 5; V2, 52 [83%] of 63; V3/V4, 29 [60%] of 48). Less commonly, fusion or combined decompression and fusion was used (V2, 7 [11%] of 63; V3/V4, 14 [29%] of 48). Most patients reported complete resolution of symptoms. The authors conclude that patients with bow hunter's syndrome classically have an impaired collateral blood flow to the brainstem. This condition carries an excellent prognosis with decompression, fusion, or combined surgery, and individual patient characteristics should guide the choice of therapy.
椎动脉旋转性闭塞（VA），即“弓猎综合征”，是椎基底动脉供血不足的一种罕见但可通过手术治疗的病因。其潜在病理机制是骨赘、纤维带或椎间盘侧方突出在颈部旋转或伸展时导致椎动脉动态狭窄。作者报告了2例此前未报道的弓猎综合征病例，并在文献综述中总结了124例已确诊病例。这2例新病例均接受了椎动脉减压和下颈椎融合手术。每例患者在椎动脉进入横突孔处左侧椎动脉均有>50%的闭塞，对侧椎动脉则终止于小脑后下动脉。通过分析126例病例（2例新病例加上之前发表的124例）的数据，作者报告狭窄部位在V1段的占4%，在V2段的占58%，在V3段的占36%，在C-1水平远端的占2%。患者多在50至70岁发病，男性多于女性。在报告了治疗类型的116例患者中，有85例（73%）对狭窄区域进行了减压（V1段，5例中的4例[80%]；V2段，63例中的52例[83%]；V3/V4段，48例中的29例[60%]）。较少采用融合或减压与融合联合手术（V2段，63例中的7例[11%]；V3/V4段，48例中的14例[29%]）。大多数患者报告症状完全缓解。作者得出结论，弓猎综合征患者典型地存在脑干侧支血流受损。这种情况通过减压、融合或联合手术预后良好，应根据个体患者特征指导治疗选择。
