Microsurgical Treatment of Bowhunter's Syndrome: 3-Dimensional Operative Video

Microsurgical Treatment of Bowhunter's Syndrome: 3-Dimensional Operative Video SURGICAL VIDEO Microsurgical Treatment of Bowhunter’s Syndrome: 3-Dimensional Operative Video Vijay Agarwal, MD, Daniel L. Barrow, MD Department of Neurosurgery, Emory University Hospital, Atlanta, Georgia Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy059 Correspondence: Vijay Agarwal, MD, Department of Neurosurgery, Emory University Hospital, 1365 Clifton Rd. NE, Suite B6200, Atlanta, GA 30322. E-mail: vijay.agarwal@emory.edu We present the case of a 56-yr-old previously healthy transverse foramen was thinned with a high-speed drill male who presented with an approximately 1-yr history under constant irrigation and Kerrison rongeurs used to of intermittent dizziness, near syncope, and holocephalic expose the vertebral artery at the site of compression. headaches when turning his head to the left side for a Importantly, the fibrotic band at, above, and below the prolonged period of time. He had a distant history of a level of compression was also dissected and removed. The previous anterior cervical discectomy and fusion at the patient tolerated the procedure well, and was discharged C6-7 level. He was neurologically intact. Static, dynamic, from thehospital2dafter surgerywithnoneurological and vascular imaging confirmed hypoplasia of the right deficits and with complete relief of his preoperative vertebral artery and dominance of the left vertebral artery symptoms. Because his symptoms completely resolved that completely filled the posterior circulation. Dynamic and have not recurred, no postoperative imaging was imaging confirmed compression of the left vertebral performed. The etiology, presentation, and microsurgical artery just above the C5-6 disc space on full head rotation treatment of this rare disease are discussed. to the left. After an anterior cervical exposure, we dissected All appropriate patient consents were obtained for this lateral to the C5-6 disc space to the transverse process. submission. The anterior tubercle was identified, and a Doppler 2017 Department of Neurosurgery, Emory University ultrasound was used to insonate the vertebral artery Hospital. Used with permission. above the level of compression. The anterior wall of the All Figures used with permission as above. KEY WORDS: Bowhunters, Anterior decompression, Vertebral artery Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy059 Received, November 6, 2017. Accepted, March 6, 2018. OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy059/4956239 by Ed 'DeepDyve' Gillespie user on 08 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Operative Neurosurgery Oxford University Press

Microsurgical Treatment of Bowhunter's Syndrome: 3-Dimensional Operative Video

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Publisher
Congress of Neurological Surgeons
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
2332-4252
eISSN
2332-4260
D.O.I.
10.1093/ons/opy059
Publisher site
See Article on Publisher Site

Abstract

SURGICAL VIDEO Microsurgical Treatment of Bowhunter’s Syndrome: 3-Dimensional Operative Video Vijay Agarwal, MD, Daniel L. Barrow, MD Department of Neurosurgery, Emory University Hospital, Atlanta, Georgia Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy059 Correspondence: Vijay Agarwal, MD, Department of Neurosurgery, Emory University Hospital, 1365 Clifton Rd. NE, Suite B6200, Atlanta, GA 30322. E-mail: vijay.agarwal@emory.edu We present the case of a 56-yr-old previously healthy transverse foramen was thinned with a high-speed drill male who presented with an approximately 1-yr history under constant irrigation and Kerrison rongeurs used to of intermittent dizziness, near syncope, and holocephalic expose the vertebral artery at the site of compression. headaches when turning his head to the left side for a Importantly, the fibrotic band at, above, and below the prolonged period of time. He had a distant history of a level of compression was also dissected and removed. The previous anterior cervical discectomy and fusion at the patient tolerated the procedure well, and was discharged C6-7 level. He was neurologically intact. Static, dynamic, from thehospital2dafter surgerywithnoneurological and vascular imaging confirmed hypoplasia of the right deficits and with complete relief of his preoperative vertebral artery and dominance of the left vertebral artery symptoms. Because his symptoms completely resolved that completely filled the posterior circulation. Dynamic and have not recurred, no postoperative imaging was imaging confirmed compression of the left vertebral performed. The etiology, presentation, and microsurgical artery just above the C5-6 disc space on full head rotation treatment of this rare disease are discussed. to the left. After an anterior cervical exposure, we dissected All appropriate patient consents were obtained for this lateral to the C5-6 disc space to the transverse process. submission. The anterior tubercle was identified, and a Doppler 2017 Department of Neurosurgery, Emory University ultrasound was used to insonate the vertebral artery Hospital. Used with permission. above the level of compression. The anterior wall of the All Figures used with permission as above. KEY WORDS: Bowhunters, Anterior decompression, Vertebral artery Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy059 Received, November 6, 2017. Accepted, March 6, 2018. OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy059/4956239 by Ed 'DeepDyve' Gillespie user on 08 June 2018

Journal

Operative NeurosurgeryOxford University Press

Published: Mar 29, 2018

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