Rotational Vertebral Artery Compression : Bow Hunter's Syndrome
A 50-year-old woman had been experiencing paroxysmal vertigo attacks for a 10 month period prior to visiting our institute. The patient's vertigo was aggravated when she turned her head to the left side. The patient underwent an inner ear exam, which was unremarkable. She was treated with conservative medication for 10 months but did not improve.\nCerebrovascular images were checked for further evaluation. From angiographic computerized tomography (CT) scans, we observed no definitive abnormal findings except for hypoplastic left VA in the neutral position (). In dynamic vertebral angiography, no steno-occlusive lesions were found in the neutral position (), but complete occlusion of right VA was found at atlanto-axial level when the patient turned her head to the left side ().\nWe decided on a surgical decompression of the left VA at the cross transverse foramen of the first cervix as the surgical approach. We placed an adhesive, fibrous bandage between the left VA and the transverse foramen. During the surgical procedure, the bandage was gently dissected and released with decompression of the surrounding bony structure. After surgery, the patient's symptoms improved, and her neck three-dimensional angiography CT scans demonstrated complete decompression of the right vertebral artery (, ). There were no follow-up complications.