Posterior inferior cerebellar artery to posterior inferior cerebellar artery in situ bypass for the treatment of bow hunter's-type dynamic ischemia in holovertebral dissection

Peter Kan, Parham Yashar, David J. Langer, Adnan H. Siddiqui, Elad I. Levy

Research output: Contribution to journalReview article

Abstract

Background: Bow hunter's syndrome is a rare cause of vertebrobasilar insufficiency arising from mechanical compression of the vertebral artery (VA) during rotation of the head. Surgical treatment usually involves direct decompression of the VA at the site of compression. We describe what is to our knowledge the first reported case of a posterior inferior cerebellar artery (PICA)-to-PICA in situ bypass for treatment of Bow hunter's-type ischemia in a patient with a VA dissection. Case Description: The patient was a 41-year-old man who developed disabling symptoms of vertebrobasilar insufficiency after trauma when he rotated his head to the right. Dynamic angiography demonstrated a chronic dissection and stasis of flow in the right VA when his head was rotated to the right, with no obvious site of focal compression. The right VA ended in the PICA and the left VA was of good caliber. A single-photon emission computed tomography study with acetazolamide challenge confirmed brainstem ischemia and poor cerebrovascular reserve. He ultimately underwent a PICA-to-PICA in situ bypass to revascularize his right PICA territory with complete symptom resolution. Conclusions: The PICA-to-PICA in situ bypass is a useful option in the treatment of Bow hunter's-type ischemia in the absence of focal structural compression of the VA or VA stenosis.

Original languageEnglish (US)
Pages (from-to)553.e15-553.e17
JournalWorld Neurosurgery
Volume78
Issue number5
DOIs
StatePublished - Nov 2012

Keywords

  • Bow hunter's-type ischemia
  • Brainstem ischemia
  • Dynamic angiography
  • PICA-to-PICA in situ bypass
  • Vertebral artery dissection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Posterior inferior cerebellar artery to posterior inferior cerebellar artery in situ bypass for the treatment of bow hunter's-type dynamic ischemia in holovertebral dissection'. Together they form a unique fingerprint.

  • Cite this