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61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

Surgical management of bow-hunter’s syndrome caused by dynamic extra-cranial vertebral artery stenosis at the cranio-cervical junction

Meeting Abstract

  • Jan Frederick Cornelius - Neurochirurgische Klinik, Heinrich-Heine Universität Düsseldorf, Deutschland; Service de neurochirurgie, Hôpital Lariboisière, Université Paris VII, Frankreich
  • Bernard George - Service de neurochirurgie, Hôpital Lariboisière, Université Paris VII, Frankreich
  • Dominique N'Dri - Service de neurochirurgie, Hôpital Lariboisière, Université Paris VII, Frankreich
  • Hans-Jakob Steiger - Neurochirurgische Klinik, Heinrich-Heine Universität Düsseldorf, Deutschland
  • Daniel Hänggi - Neurochirurgische Klinik, Heinrich-Heine Universität Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1532

DOI: 10.3205/10dgnc009, URN: urn:nbn:de:0183-10dgnc0094

Veröffentlicht: 16. September 2010

© 2010 Cornelius et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The dynamic vertebral artery stenosis (V3-segment) is a rare disease causing severe deficits within the posterior circulation. The goal of the present study was to analyze the diagnostic and therapeutic management in a series of patients suffering from symptomatic dynamic extra-cranial vertebral artery stenosis at the cranio-cervical junction (bow hunter’s syndrome).

Methods: A retrospective clinical study of patients presenting with dynamic vertebral artery stenosis in the V3 segment over the last decade in two tertiary care centres with special interest in cerebro-vascular pathology was performed. The patient population comprised a total of 5 patients.

Results: There were 4 men and 1 woman with ages ranging from 8–46 years. The main symptoms were vertigo and visual blur during specific head movements. With extreme movements, syncopes occurred. One patient suffered a stroke in the posterior circulation. Diagnosis was done in all patients by dynamic angiography assessing vertebral artery filling during head movements in all directions. The compression was always located at the V3 segment. In all cases the compressed VA was the dominant one. Furthermore, posterior communicating arteries were hypo- or aplastic. Four patients were operated by an antero-lateral cervical approach and a decompression of the vertebral artery was realized. One patient was decompressed via a postero-lateral approach. In this patient a fusion was done simultaneously because of pre-existing instability. No serious complication was encountered. All patients became and remained asymptomatic post-operatively. Early dynamic angiography confirmed good flow in the VA.

Conclusions: Symptomatic dynamic vertebral artery stenosis at the cranio-cervical junction is extremely rare and diagnosis often delayed. However, as the symptoms are almost pathognomonic (bow-hunter’s syndrome), diagnosis should be prompt. Dynamic angiography is the gold standard. The present clinical series demonstrated that decompression via the antero-lateral approach may be very efficient and associated with low morbidity.