Artikel
Surgical management of bow-hunter’s syndrome caused by dynamic extra-cranial vertebral artery stenosis at the cranio-cervical junction
Suche in Medline nach
Autoren
Veröffentlicht: | 16. September 2010 |
---|
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.