Ahn JH, Jun HS, Kim IK, Kim CH, Lee SJ. Atypical case of bow hunter’s syndrome linked to aberrantly coursing vertebral artery: A case report. World J Clin Cases 2023; 11(35): 8399-8403 [PMID: 38130620 DOI: 10.12998/wjcc.v11.i35.8399]
Corresponding Author of This Article
Seung Jin Lee, MD, Assistant Professor, Department of Neurosurgery, Kangwon National University School of Medicine, Kangwon National University Hospital, No. 156 Baengnyeong-ro, Gangwon-do, Chuncheon-si 24289, South Korea. rabbit3540@empas.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 16, 2023; 11(35): 8399-8403 Published online Dec 16, 2023. doi: 10.12998/wjcc.v11.i35.8399
Atypical case of bow hunter’s syndrome linked to aberrantly coursing vertebral artery: A case report
Jun Hyong Ahn, Hyo Sub Jun, In Kyeong Kim, Choong Hyo Kim, Seung Jin Lee
Jun Hyong Ahn, Hyo Sub Jun, In Kyeong Kim, Choong Hyo Kim, Seung Jin Lee, Department of Neurosurgery, Kangwon National University School of Medicine, Kangwon National University Hospital, Gangwon-do, Chuncheon-si 24289, South Korea
Author contributions: Ahn JH and Lee SJ contributed to manuscript writing and editing, and data collection; Jun HS contributed to data analysis; Kim IK and Kim CH contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seung Jin Lee, MD, Assistant Professor, Department of Neurosurgery, Kangwon National University School of Medicine, Kangwon National University Hospital, No. 156 Baengnyeong-ro, Gangwon-do, Chuncheon-si 24289, South Korea. rabbit3540@empas.com
Received: September 13, 2023 Peer-review started: September 13, 2023 First decision: November 22, 2023 Revised: November 27, 2023 Accepted: December 6, 2023 Article in press: December 6, 2023 Published online: December 16, 2023 Processing time: 91 Days and 22 Hours
Abstract
BACKGROUND
In bow hunter’s syndrome (BHS), also known as rotational vertebral artery (VA) syndrome, there is dynamic/rotational compression of the VA producing vertebrobasilar insufficiency. Most occurrences involve atlantoaxial rather than mid-cervical VA compromise, the latter being rarely reported. Herein, we detail successful VA decompression at mid-cervical spine, given a departure from its usual course.
CASE SUMMARY
The patient, a 45-year-old man, presented to our hospital with occipital headache and vertigo. Computed tomography angiography showed anomalous C4 entry of right VA, with compression upon head rotation to that side. Thyroid cartilage and anterior tubercle of C5 transverse process were visibly at fault. We opted for surgery, using an anterior cervical approach to remove the anterior tubercle. Patient recovery was uneventful and brought resolution of all preoperative symptoms.
CONCLUSION
BHS is an important consideration where aberrant coursing of VA and neurologic symptoms coexist.
Core Tip: Herein, we report a rare case of bow hunter’s syndrome (BHS) induced by dynamic/rotational compression of the vertebral artery (VA) at the mid-cervical level associated with anomalous entry of the VA at C4. The VA was dynamically compressed between the thyroid cartilage and the anterior tubercle of the C5 transverse process upon right rotation. Complete symptom relief followed excision of the offending tubercle. BHS usually involves the atlantoaxial, rather than mid-cervical, VA. BHS linked to anomalous entry of the VA has rarely been reported. This case involves a rare etiology of BHS and a unique approach to its management.
