Bow hunter’s syndrome: case report

Abstract

Objective: Describe the clinical presentation, diagnostic challenges, and surgical management of Bow Hunter’s Syndrome, detailing the operative strategy, technical considerations, and postoperative outcomes associated with decompressing the mechanically compressed vertebral artery. Case Presentation. A 41-years-old man with a history of multiple cervical injections presented with an eleven-month history of gait disturbance and chronic vertigo, exclusively induced by rightward head rotation and relieved in the neutral position. Neurological examination was largely unremarkable aside from features consistent with vertebrobasilar insufficiency. Dynamic angiography demonstrated an >80% reduction in the caliber of the left vertebral artery during contralateral head rotation. Surgical decompression was thererefore indicated. Intraoperatively, several fibrous bands compressing the vertebral artery were identified and resected, and the C1 transverse foramen was enlarged to achieve complete decompression. Postoperatively the patient experienced an uneventful recovery, with full resolution of symptoms and imaging confirming adequate decompression. Conclusion: Prior cervical interventions may predispose to the development of fibrous adhesions and should be considered during etiologic assessment. Surgical decompression can provide definitive symptom resolution in patients with refractory or disabling dynamic vertebrobasilar insufficiency.