Bow hunter's syndrome caused by accessory cervical ossification: posterolateral decompression and the use of intraoperative Doppler ultrasonography

Abstract Background Bow hunter's syndrome refers to symptomatic vertebrobasilar insufficiency provoked by physiologic head rotation. Case Description We report a unique case of bow hunter's syndrome caused by an accessory cervical ossification and the first use of intraoperative Doppler ul...

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Bibliographic Details
Published in:Surgical neurology 2007-02, Vol.67 (2), p.169-171
Main Authors: Whitmore, Robert G., BA, MD, Simon, Scott L., MD, Hurst, Robert W., MD, Nisenbaum, Harvey L., MD, Kasner, Scott E., MD, Zager, Eric L., MD, PhD
Format: Article
Language:English
Subjects:
Accidents, Traffic
Biological and medical sciences
Bow hunter's
Calcinosis - complications
Calcinosis - diagnosis
Calcinosis - surgery
Cerebral Angiography
Cervical Vertebrae - abnormalities
Cervical Vertebrae - diagnostic imaging
Cervical Vertebrae - surgery
Decompression, Surgical - methods
Humans
Intraoperative Doppler ultrasound
Male
Medical sciences
Middle Aged
Monitoring, Intraoperative - methods
Neurology
Neurosurgery
Neurosurgical Procedures - methods
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Treatment Outcome
Ultrasonography, Doppler - methods
Vascular Surgical Procedures - methods
Vertebral Artery - diagnostic imaging
Vertebral Artery - pathology
Vertebral Artery - surgery
Vertebrobasilar insufficiency
Vertebrobasilar Insufficiency - etiology
Vertebrobasilar Insufficiency - physiopathology
Vertebrobasilar Insufficiency - surgery
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Summary:Abstract Background Bow hunter's syndrome refers to symptomatic vertebrobasilar insufficiency provoked by physiologic head rotation. Case Description We report a unique case of bow hunter's syndrome caused by an accessory cervical ossification and the first use of intraoperative Doppler ultrasonography directly upon the vertebral artery during the surgical repair. After a traumatic motor-vehicle collision, the patient developed recurrent syncopal episodes when he turned his head abruptly to the right. Transcranial Doppler studies and vertebral angiography with the patient's neck rotated into the symptomatic position revealed marked reduction of vertebral artery flow, and fine-cut CT of the upper cervical spine demonstrated the compressive accessory ossicle. Intraoperative Doppler ultrasound performed with the head in neutral and rotated positions, before and after surgical decompression, demonstrated restoration of blood flow in the vertebral artery. We discuss the mechanisms of bow hunter's syndrome and the advantages of intraoperative Doppler ultrasonography. Conclusion This case describes the first use of intraoperative Doppler ultrasonography directly upon the vertebral artery to provide an unrestricted real-time assessment of the surgical decompression for bow hunter's syndrome.
ISSN:0090-3019
1879-3339
DOI:10.1016/j.surneu.2006.06.035