Enomoto Noriya, Yagi Kenji, Matsubara Shunji, Uno Masaaki
Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan.
Front Neurol. 2021 Oct 26;12:756838. doi: 10.3389/fneur.2021.756838. eCollection 2021.
Bow hunter's syndrome (BHS) is most commonly caused by compression of the vertebral artery (VA). It has not been known to occur due to an extracranially originated posterior inferior cerebellar artery (PICA), the first case of which we present herein. A 71-year-old man presented with reproducible dizziness on leftward head rotation, indicative of BHS. On radiographic examination, the bilateral VAs merged into the basilar artery, and the left VA was predominant. The right PICA originated extracranially from the right VA at the atlas-axis level and ran vertically into the spinal canal. During the head rotation that induced dizziness, the right PICA was occluded, and a VA stenosis was revealed. Occlusion of the PICA was considered to be the primary cause of the dizziness. The patient underwent surgery to decompress the right PICA and VA a posterior cervical approach. Following surgery, the patient's dizziness disappeared, and the stenotic change at the right VA and PICA improved. The PICA could be a causative artery for BHS when it originates extracranially at the atlas-axis level, and posterior decompression is an effective way to treat it.
弓状猎人综合征（BHS）最常见的病因是椎动脉（VA）受压。目前尚不清楚它是否由颅外起源的小脑后下动脉（PICA）引起，本文首次报道了这种情况。一名71岁男性因向左转头时出现可重复性头晕前来就诊，提示为BHS。影像学检查显示，双侧椎动脉汇入基底动脉，左侧椎动脉为主。右侧PICA在寰枢椎水平从右侧椎动脉颅外起源，垂直进入椎管。在诱发头晕的头部旋转过程中，右侧PICA被阻塞，同时发现椎动脉狭窄。PICA阻塞被认为是头晕的主要原因。患者接受了手术，采用后路颈椎入路对右侧PICA和椎动脉进行减压。术后，患者头晕消失，右侧椎动脉和PICA的狭窄改变有所改善。当PICA在寰枢椎水平颅外起源时，它可能是BHS的致病动脉，后路减压是治疗该病的有效方法。
