Transient rotational compression of the vertebral artery caused by herniated cervical disc

2003 ◽  
Vol 98 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Andrew N. Nemecek ◽  
David W. Newell ◽  
Robert Goodkin
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Cervical Disc ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Vertebrobasilar Ischemia ◽  
Extrinsic Compression ◽  
The Many ◽  
Herniated Cervical Disc ◽  
Adequate Decompression

✓ Of the many causes of vertebrobasilar insufficiency (VBI), extrinsic compression of the vertebral artery (VA) is relatively uncommon. A syndrome of VBI caused by extrinsic compression of the VA secondary to head rotation has been termed positional vertebrobasilar ischemia. The authors present a case of transient VBI caused by herniation of a cervical disc. Transcranial Doppler ultrasonography was used preoperatively to confirm the diagnosis and intraoperatively to monitor cerebral perfusion and to confirm that adequate decompression of the VA had been achieved.

Positional vertebral artery compression and vertebrobasilar insufficiency due to a herniated cervical disc

2009 ◽  
Vol 11 (3) ◽  
pp. 326-329 ◽  
Author(s):  
Kenta Ujifuku ◽  
Kentaro Hayashi ◽  
Keishi Tsunoda ◽  
Naoki Kitagawa ◽  
Tomayoshi Hayashi ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Histopathological Examination ◽  
Head Rotation ◽  
Cervical Disc ◽  
Decompression Surgery ◽  
Vertebrobasilar Insufficiency ◽  
Intraoperative Angiography ◽  
The Right ◽  
Vertebral Artery Compression ◽  
Herniated Cervical Disc

The authors report a case of vertebrobasilar insufficiency caused by vertebral artery (VA) compression due to a herniated cervical disc, which was surgically treated with the aid of intraoperative angiography. This 78-year-old man visited the hospital because of syncope following head rotation. Admission CT scans revealed a calcified mass adjacent to the right lateral process of the C-4 spine. Cervical angiography demonstrated an obstruction of the right VA at this region on rotation of the head to the right. The operation revealed a cervical disc protruding toward the right VA. The disc was surgically removed, and then the decompression of the right VA was confirmed on intraoperative angiography studies. A histopathological examination showed fibrohyaline cartilage, indicating an ossified intervertebral disc. The postoperative course was uneventful, and he has not experienced any syncope since treatment. A cervical disc herniation could be a cause of vertebrobasilar insufficiency by exerting positional compression of the VA. Intraoperative angiography could be quite useful to confirm this condition during decompression surgery for a cervical VA.

Rotational vertebrobasilar insufficiency as a component of thoracic outlet syndrome resulting in transient blindness

1994 ◽  
Vol 81 (4) ◽  
pp. 617-619 ◽  
Author(s):  
James J. Sell ◽  
Jesse R. Rael ◽  
William W. Orrison
Keyword(s):  
Vertebral Artery ◽  
Thoracic Outlet Syndrome ◽  
Head Rotation ◽  
Cortical Blindness ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Aged Woman ◽  
Extrinsic Compression ◽  
Vertebral Artery Compression

✓ Cases of unilateral vertebral artery compression associated with thoracic outlet syndrome infrequently result in symptoms and, of those that do, most involve the brain stem. Reports of transient blindness resulting from this condition are even more rare. The authors describe the case of a middle-aged woman who presented with transient blindness when she turned her head excessively to the left. She also exhibited other less severe brainstem symptoms. Arteriography demonstrated occlusion of the left vertebral artery only when her head was rotated to the left. Surgical exploration revealed entrapment of the left vertebral artery by a tight anterior scalene muscle, release of which resulted in complete resolution of her symptoms. Both neurosurgeons and radiologists need to be aware that extrinsic compression of the vertebral artery precipitated by head rotation may sometimes result in transient cortical blindness.

Carotid to distal vertebral artery bypass for vertebrobasilar ischemia

1984 ◽  
Vol 60 (1) ◽  
pp. 187-189 ◽  
Author(s):  
Perry E. Camp
Keyword(s):  
Vertebral Artery ◽  
Simple Technique ◽  
Artery Bypass ◽  
Vertebrobasilar Insufficiency ◽  
Venous Graft ◽  
Content Type ◽  
Vertebrobasilar Ischemia ◽  
Extracranial Vertebral Artery ◽  
The Common ◽  
Collateral Vessels

✓ A simple technique is described for a venous graft between the common carotid artery and the extracranial vertebral artery. In the case described, the vertebral artery was shown angiographically to be occluded and reconstituted by collateral vessels. This patient had symptoms of vertebrobasilar insufficiency which resolved postoperatively.

Bow hunter stroke caused by cervical disc herniation

2002 ◽  
Vol 96 (1) ◽  
pp. 90-93 ◽  
Author(s):  
G. Edward Vates ◽  
Kevin C. Wang ◽  
David Bonovich ◽  
Christopher F. Dowd ◽  
Michael T. Lawton
Keyword(s):  
Craniocervical Junction ◽  
Left Vertebral Artery ◽  
Cervical Disc ◽  
Head Turning ◽  
Content Type ◽  
Vertebrobasilar Ischemia ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
History Of ◽  
Herniated Cervical Disc

✓ Bow hunter stroke, which is characterized by transient vertebrobasilar ischemia brought on by head turning, is an unusual condition usually caused by structural abnormalities at the craniocervical junction. The authors present a case in which compression of the left vertebral artery (VA) at the C4–5 level was caused by a laterally herniated intervertebral disc. A 56-year-old man presented with a 6-month history of dizziness and syncope when he turned his head 45° or more to the left. Transcranial Doppler (TCD) ultrasonography demonstrated decreased blood flow through the left VA, and angiography revealed an occlusion of the left VA at the C4–5 level, both when the patient turned his head to the left. Via an anterior cervical approach, the VA canal was unroofed through the transverse foramina to decompress the left VA at C4–5; intraoperatively, the left VA was found to be compressed by a laterally herniated cervical disc fragment. To the best of the authors' knowledge this is the first report of a laterally herniated cervical disc causing bow hunter stroke. The use of TCD may be of value in the diagnosis and management of the disorder, and herniated cervical disc must be included in the roster of potential causes for this rare disease.

Comparison of C1–2 posterior fusion and decompression of the vertebral artery in the treatment of bow hunter's stroke

1997 ◽  
Vol 86 (4) ◽  
pp. 619-623 ◽  
Author(s):  
Takeshi Matsuyama ◽  
Tetsuya Morimoto ◽  
Toshisuke Sakaki
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Posterior Fusion ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Long Term Follow Up ◽  
Life Threatening ◽  
Neck Rotation ◽  
Bow Hunter’S Stroke

✓ Bow hunter's stroke results from vertebrobasilar insufficiency caused by mechanical occlusion or stenosis of the vertebral artery (VA) at the C1–2 level on head rotation. Surgical treatment of this condition may be chosen to avoid life-threatening accidents or because patients complain that conservative treatments such as verbal warnings or use of a neck brace to limit head and neck rotation are ineffective and thus restrict their lifestyle. Posterior fusion involving C1–2 has long been used to limit atlantoaxial rotational movements. However, it has the serious disadvantage that the range of head motion is severely reduced. Recently, decompression of the atlantoaxial portions of the affected VA has been used because it does not limit physiological neck movements. However, no long-term follow-up review of patients who have undergone this procedure has been conducted, and it is unclear whether this procedure always provides relief of symptoms. To answer this question, the results of C1–2 posterior fusion were compared with decompression of the VA for the treatment of bow hunter's stroke.

Rotational compression of the vertebral artery at the point of dural penetration

2000 ◽  
Vol 93 (2) ◽  
pp. 300-303 ◽  
Author(s):  
Ziya Akar ◽  
Ali M. Kafadar ◽  
Necmettin Tanriover ◽  
Reza S. Dashti ◽  
Civan Islak ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Thrombus Formation ◽  
Posterior Inferior Cerebellar Artery ◽  
Signs And Symptoms ◽  
Head Rotation ◽  
Cerebellar Infarction ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Number Of Patients ◽  
Fine Print

✓ Vertebrobasilar insufficiency (VBI) due to vertebral artery (VA) compression occurs in a significant number of patients. Rotational compression of the VA usually occurs below C-2, where the artery is pinched during head rotation, leading to thrombus formation and subsequent cerebellar infarction. Although this problem has been reported to occur at the atlantooccipital levels, a review of the literature revealed no published cases of VA compression at the point of dural penetration, which is located above the atlantooccipital membrane. The authors report the case of a 30-year-old woman who presented with signs and symptoms of VBI. Dynamic angiography demonstrated left-sided VA compression at the site at which dural penetration had occurred, proximal to the posterior inferior cerebellar artery. Surgical decompression of the left VA at the point of dural penetration relieved the symptoms, and postoperative dynamic angiography demonstrated complete resolution of the positional compression of the left VA. Because of these findings, an additional possible location for rotational compression of the VA is described, namely, the point of dural penetration. The authors suggest a method of surgically treating rotational VA compression at this site.

Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery

1995 ◽  
Vol 83 (4) ◽  
pp. 737-740 ◽  
Author(s):  
Mark W. Fox ◽  
David G. Piepgras ◽  
John D. Bartleson
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Artery Occlusion ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Mechanical Compression ◽  
Head Turning ◽  
Content Type ◽  
The Right ◽  
Bow Hunter’S Stroke

✓ A case of repeated vertebrobasilar ischemic attacks related to head rotation (bow hunter's stroke) is reported. With head rotation of 45° or more to the right, the patient would become lightheaded and feel as if she were going to lose consciousness. Angiography performed when head rotation was to the right revealed mechanical compression of the left vertebral artery at the foramen transversarium of the axis and an occluded right vertebral artery. Untethering of the vertebral artery as it passed through the foramen transversarium of the atlas in this case completely relieved the patient's symptoms. The authors conclude that contralateral vertebral artery occlusion predisposed this patient to symptomatic vertebrobasilar insufficiency secondary to ipsilateral vertebral artery mechanical stenosis induced by head turning.

Atlanto-Occipital Decompression of Vertebral Artery for a Variant of Bow Hunter's Syndrome: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Nickalus R Khan ◽  
Turki Elarjani ◽  
Stephanie H Chen ◽  
Laszlo Miskolczi ◽  
Sheryl Strasser ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Rare Condition ◽  
Head Rotation ◽  
Treatment Modalities ◽  
Spinal Instability ◽  
Vertebrobasilar Insufficiency ◽  
Common Etiology ◽  
Neurologically Intact ◽  
Hunter's Syndrome ◽  
Visual Abnormalities

Abstract Rotational vertebral artery (VA) occlusion syndrome, also known as bow hunter's syndrome, is an uncommon variant of vertebrobasilar insufficiency typically occurring with head rotation.1-3 The most common presenting symptom is dizziness (76.8%), followed by visual abnormalities and syncope (50.4% and 40.4%, respectively).2 Osteophytic compression due to spinal spondylosis has been shown to be the most common etiology (46.2%), with other factors, such as a fibrous band, muscular compression, or spinal instability, being documented.1,2 Treatment is dependent on the level and site of VA compression with anterior, anterolateral, or posterior approaches being described.1,4 We present the case of a 72-yr-old male with osteophytic compression of the V3 segment of the vertebral artery at the occipital-cervical junction. The patient underwent a C1 hemilaminectomy and removal of osteophytic compression from the occipital-cervical joint. The patient had complete resolution of compression of his vertebral artery on postoperative imaging and remained neurologically intact following the procedure. We review the literature on this topic, the technical nuances of the procedure performed, and review the different treatment modalities available for this rare condition.1-11  The patient consented to the procedure and to publication of their image.

Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band

1982 ◽  
Vol 56 (4) ◽  
pp. 581-583 ◽  
Author(s):  
Timothy Mapstone ◽  
Robert F. Spetzler
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Vertebrobasilar Insufficiency ◽  
Fibrous Band ◽  
Content Type ◽  
Vertebral Artery Occlusion ◽  
The Right ◽  
Band Crossing ◽  
Fine Print

✓ A case is described in which vertebral artery occlusion, caused by a fibrous band, occurred whenever the patient turned his head to the right side, resulting in vertigo and syncope whenever the head was turned to the right. Release of a fibrous band crossing the vertebral artery 2 cm from its origin relieved the patient's vertebral artery constriction and symptoms.

Rotational Vertebrobasilar Ischemia: Hemodynamic Assessment and Surgical Treatment

Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Marcelo D. Vilela ◽  
Robert Goodkin ◽  
David A. Lundin ◽  
David W. Newell
Keyword(s):  
Surgical Treatment ◽  
Vertebral Artery ◽  
Transcranial Doppler ◽  
Posterior Circulation ◽  
Long Term Results ◽  
Vertebrobasilar Insufficiency ◽  
Head Turning ◽  
Vertebrobasilar Ischemia ◽  
Hemodynamic Assessment ◽  
Vertebral Artery Compression

Abstract OBJECTIVE: Rotational vertebrobasilar insufficiency is a severe and incapacitating condition. Proper investigation and management are essential to reestablish normal posterior circulation hemodynamics, improve symptoms, and prevent stroke. We present a series of 10 patients with rotational vertebrobasilar ischemia who were treated surgically and emphasize the importance of transcranial Doppler in the diagnosis and management of this condition. METHODS: All patients presented with symptoms of vertebrobasilar insufficiency induced by head turning. Transcranial Doppler documented a significant decrease in the posterior cerebral artery velocities during head turning that correlated with the symptoms in all patients. A dynamic cerebral angiogram was performed to demonstrate the site and extent of vertebral artery compression. RESULTS: The surgical technique performed was tailored to each individual patient on the basis of the anatomic location, pathogenesis, and mechanism of the vertebral artery compression. Five patients underwent removal of osteophytes at the level of the subaxial cervical spine, one patient had a discectomy, two patients had a decompression only at the level of C1–C2, and two patients had a decompression and fusion at the C1–C2 level. CONCLUSION: The transcranial Doppler is extremely useful to document the altered hemodynamics preoperatively and verify the return of normal posterior circulation velocities after the surgical decompression in patients with rotational vertebrobasilar ischemia. Surgical treatment is very effective, and excellent long-term results can be expected in the vast majority of patients after decompression of the vertebral artery.

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