Rotational Vertebral Artery Compression : Bow Hunter's Syndrome
A 42-year old woman reported severe vertigo, dizziness, right upper extremity tingling sensations and aggravated syncope when she turned her head to the right. Upon otolaryngological examination, she presented right beating nystagmus when her head was rotated to the right in the sitting or supine position. There were no abnormal findings except for hypoplasia of the posteroinferior cerebellar artery termination of the left VA on magnetic resonance angiography. No significant changes were observed with neck rotational positions.\nHowever, dynamic cerebroangiography showed no steno-occlusive lesions of left VA in the neutral position (), but an occlusion of the left VA was observed at the C1-2 level from right head rotation (). We performed decompressive surgery based on a diagnosis of BHS. We selected a surgical approach and found an adhesion between the left VA and transverse foramen. We performed a decompressive transversarium foraminectomy.\nAfter the surgery, CT angiography showed a released left VA. The patient experienced a complete recovery.