Atlanto-occipital decompression of vertebral artery for a variant of bow hunter's syndrome: 2-dimensional operative video

Nickalus R. Khan, Turki Elarjani, Stephanie H. Chen, Laszlo Miskolczi, Sheryl Strasser, Jacques J. Morcos

Research output: Contribution to journalComment/debatepeer-review


Rotational vertebral artery (VA) occlusion syndrome, also known asbowhunter's syndrome, is an uncommonvariant of vertebrobasilar insufficiency typically occurring with head rotation. The most common presenting symptom is dizziness (76.8%), followed by visual abnormalities and syncope (50.4% and 40.4%, respectively). Osteophytic compression due to spinal spondylosis has been shown to be the most common etiology (46.2%), with other factors, such as a fibrous band, muscular compression, or spinal instability, being documented. Treatment is dependent on the level and site of VA compression with anterior, anterolateral, or posterior approaches being described. We present the case of a 72-yr-old male with osteophytic compression of the V3 segment of the vertebral artery at the occipital-cervical junction. The patient underwent a C1 hemilaminectomy and removal of osteophytic compression from the occipital-cervical joint. The patient had complete resolution of compression of his vertebral artery on postoperative imaging and remained neurologically intact following the procedure. We review the literature on this topic, the technical nuances of the procedure performed, and review the different treatment modalities available for this rare condition. The patient consented to the procedure and to publication of their image.

Original languageEnglish (US)
Pages (from-to)E363-E364
JournalOperative Neurosurgery
Issue number4
StatePublished - Oct 1 2021


  • Atlas
  • Bow Hunter's Syndrome
  • Condyle
  • Occipito-cervical joint
  • Transposition
  • Vertebral artery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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