Intraoperative dynamic angiography to detect resolution of Bow Hunter's syndrome: technical case report

BackgroundBow Hunter's syndrome is a rare form of vertebrobasilar insufficiency that may be successfully treated by surgical intervention. Use of intraoperative dynamic transcranial Doppler ultrasound for surgical treatment of vertebrobasilar insufficiency has been described in literature. However, this technique was inconsistent and unreliable in some patients. We present a case of a patient with Bow Hunter's syndrome treated surgically and emphasize the valuable addition of intraoperative dynamic angiography to determine resolution of vertebral artery compromise.Case DescriptionThe patient was a 58-year-old man with complaints of dizziness, vertigo, and near-syncopal episodes that occurred when he rotated his head to the left. Imaging revealed compromise of the dominant left vertebral artery with leftward head rotation. An anterior cervical approach with decompression of the left subaxial vertebral artery was performed. Significant osteophyte formation was observed. Removal of bone and decompression of the vertebral artery was performed. Intraoperative dynamic angiography confirmed resolution of vertebral artery compression and minimized the amount of decompression. No further intervention was required.ConclusionIntraoperative dynamic angiography is a definitive test to determine hemodynamic resolution of Bow Hunter's syndrome. It offers real-time feedback of vertebral artery decompression, potentially minimizes the amount of decompression, and can be performed safely.