Bow Hunter Syndrome Treated Via an Anterior Approach and Selective Decompression Only

Soo Bin Im

doi:10.26717/bjstr.2018.09.001870

Abstract

Bow Hunter Syndrome Treated Via an Anterior Approach and Selective Decompression Only

Highlights

Dizziness triggered by rotating the head is a characteristic symptom of Bow hunter syndrome (BHS)
When the head was turned to the right, digital subtraction angiography (DSA) showed that blood flow decreased at the C3–4 level and stopped at the C2 level
This case indicates that the stenotic point associated with BHS should be determined its exact stenotic point and surgical treatment should be individualized based on the stenotic point

Summary

Introduction

Dizziness triggered by rotating the head is a characteristic symptom of BHS. dizziness has many causes, and patients who complain of dizziness provoked by rotating the head should be evaluated in terms of a peripheral disorder, such as benign paroxysmal positional vertigo (BPPV). A 38-year-old male suffering from alcoholism visited our outpatient department complaining of repeated dizziness and a buzzing sound in the left ear His first ear symptom was a hearing difficulty commencing 1 year prior. No symptoms were evident when the head was rotated to the left or in the neutral position. CTA revealed a hypoplastic right VA and left VA stenosis at the lateral curvature of the VA just below the C2 transverse foramen. DSA was performed in three positions (with the head neutral, 90° to the left, and 90° to the right). When the head was turned to the left, the VA stenotic lesion became wider than in the neutral position. We concluded that the left VA became kinked just below the entry point of the C2 transverse foramen when the head was turned to the right. Neck movement was not limited, and no cervical spine instability was evident on a dynamic X-ray

Discussion

Conclusion