Bow Hunter's Syndrome: Surgical Management (Video) and Review of the Literature

BACKGROUND: Bow Hunter's syndrome (BHS) is a rare condition characterized by vertebrobasilar insufficiency associated with rotational vertebral artery occlusion during head movement. Many existing reports describe surgical management, although no single technique has proven superior. OBJECTIVE: To review all reported cases of BHS with focus on outcomes of individual techniques as well as to present a video report of a posterior decompression without fusion performed at the authors' institution. METHODS: We searched PubMed for all relevant articles of BHS available in the English language. Pertinent studies were further characterized into surgical technique performed and associated outcomes. RESULTS: We included 27 studies in our review, excluding the case presented, for a total of 65 cases of BHS. These cases discuss anterior versus posterior decompressions, the need for fusion, coil embolization techniques, the efficacy of intraoperative dynamic angiography, and success rate with symptom resolution being the primary endpoint. A total of 53 cases underwent decompression without fusion, with an overall success rate of 90.6% (n [48/53). Similarly, eleven cases underwent decompression with fusion, with a success rate of 91% (n [10/11). Two additional cases opted for coil embolization, one of which reported resolution of symptoms. Furthermore, we present a video case of a posterior decompression without fusion with resolution of symptoms. CONCLUSIONS: BHS remains a rare clinical condition with no clear superior method of treatment. Rates of symptom resolution are similar among cases undergoing decompression with or without fusion. Coil embolization has been reported with limited success in 2 cases.