Vertical Bow Hunter’s Syndromes Caused by C1 Pedicle Screw Compression: Case Report and Literature Review

Shuo-Chi Chien1, Chieh-Tsai Wu1, Ching-Chang Chen1,2, Mun-Chun Yeap1, Ting-Wei Chang1,2, Po-Chuan Hsieh1,2 and Chun-Ting Chen1,2*

1Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taiwan
2New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), Taiwan

^*Correspondance to: Chun-Ting Chen 

 PDF  Full Text DOI: 10.25107/2474-1647.3564

Abstract

Bow Hunter’s syndromes are well-described reproducible Vertebral Artery (VA) compression syndromes that occur during horizontal head rotation. It’s rare that occurred during neck extension and caused by C1 pedicle screw compression, which was so-called vertical Bow Hunter’s syndromes. Here, an adult patient was reported who received C1-C2 pedicle screws and plates fusion surgery and suffered from dizziness when extending his neck after one year postoperatively. Repeated basilar artery occlusions were also noted. Dynamic angiography confirmed left VA stenosis caused by C1 pedicle screw compression during neck extension. As we know, this is the first iatrogenic case of vertical Bow Hunter’s syndromes. After screw removal, left VA pseudoaneurysm and cerebellar infarction with hemorrhagic transformation were found unexpectedly. Endovascular placement of covered stent was used for obliteration of the pseudoaneurysm. The patient had good clinical recovery without residual sequala after treatment.

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Cite the article

Chien S-C, Wu C-T, Chen C-C, Yeap M-C, Chang T-W, Hsieh P-C, et al. Vertical Bow Hunter’s Syndromes Caused by C1 Pedicle Screw Compression: Case Report and Literature Review. Clin Surg. 2022; 7: 3564.