{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:04:00Z","timestamp":1786125840676,"version":"build-2736575974"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T00:00:00Z","timestamp":1625011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Rotational vertebral artery (VA) occlusion syndrome, also known as bow hunter's syndrome, is an uncommon variant of vertebrobasilar insufficiency typically occurring with head rotation.\n                    <jats:sup>1-3<\/jats:sup>\n                    The most common presenting symptom is dizziness (76.8%), followed by visual abnormalities and syncope (50.4% and 40.4%, respectively).\n                    <jats:sup>2<\/jats:sup>\n                    Osteophytic compression due to spinal spondylosis has been shown to be the most common etiology (46.2%), with other factors, such as a fibrous band, muscular compression, or spinal instability, being documented.\n                    <jats:sup>1,2<\/jats:sup>\n                    Treatment is dependent on the level and site of VA compression with anterior, anterolateral, or posterior approaches being described.\n                    <jats:sup>1,4<\/jats:sup>\n                    We present the case of a 72-yr-old male with osteophytic compression of the V3 segment of the vertebral artery at the occipital-cervical junction. The patient underwent a C1 hemilaminectomy and removal of osteophytic compression from the occipital-cervical joint. The patient had complete resolution of compression of his vertebral artery on postoperative imaging and remained neurologically intact following the procedure. We review the literature on this topic, the technical nuances of the procedure performed, and review the different treatment modalities available for this rare condition.\n                    <jats:sup>1-11<\/jats:sup>\n                  <\/jats:p>\n                  <jats:p>\u2003The patient consented to the procedure and to publication of their image.<\/jats:p>","DOI":"10.1093\/ons\/opab231","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T23:54:23Z","timestamp":1625097263000},"page":"E363-E364","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Atlanto-Occipital Decompression of Vertebral Artery for a Variant of Bow Hunter's Syndrome: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4099-089X","authenticated-orcid":false,"given":"Nickalus R","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9583-6123","authenticated-orcid":false,"given":"Turki","family":"Elarjani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie H","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laszlo","family":"Miskolczi","sequence":"additional","affiliation":[{"name":"Holy Cross Health, Ft Lauderdale, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheryl","family":"Strasser","sequence":"additional","affiliation":[{"name":"Holy Cross Health, Ft Lauderdale, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques J","family":"Morcos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,10]]},"reference":[{"issue":"4","key":"bib1-20250821","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1227\/NEU.0b013e3181ee36db","article-title":"Rotational vertebral artery occlusion\u2014series of 9 cases","volume":"67","author":"Lu","year":"2010","journal-title":"Neurosurgery"},{"key":"bib2-20250821","article-title":"Subaxial vertebral artery rotational occlusion syndrome: an overview of clinical aspects, diagnostic work-up, and surgical management [published online ahead of print: September 10, 2020]","author":"Luzzi","journal-title":"Asian Spine J"},{"issue":"6","key":"bib3-20250821","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.surneu.2005.08.016","article-title":"Rotational vertebral artery insufficiency resulting from cervical spondylosis: case report and review of the literature","volume":"65","author":"Bulsara","year":"2006","journal-title":"Surg Neurol"},{"issue":"2","key":"bib4-20250821","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1080\/01616412.2020.1831303","article-title":"Anterolateral approach for subaxial vertebral artery decompression in the treatment of rotational occlusion syndrome: results of a personal series and technical note","volume":"43","author":"Luzzi","year":"2020","journal-title":"Neurol Res"},{"key":"bib5-20250821","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/978-3-319-62515-7_22","article-title":"Compression syndromes of the vertebral artery at the craniocervical junction","volume":"125","author":"Cornelius","year":"2019","journal-title":"Acta Neurochir Suppl"},{"issue":"1","key":"bib6-20250821","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jvscit.2018.09.006","article-title":"Rotational vertebral artery occlusion secondary to completely extraosseous vertebral artery","volume":"5","author":"Rendon","year":"2019","journal-title":"J Vasc Surg Cases Innov Tech"},{"issue":"2","key":"bib7-20250821","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1097\/BSD.0b013e3182886fbf","article-title":"Subaxial rotational vertebral artery syndrome: resection of the uncinate process and anterior fusion can be sufficient!: case report and review of the literature","volume":"28","author":"Schelfaut","year":"2015","journal-title":"J Spinal Disord Tech"},{"issue":"9","key":"bib8-20250821","doi-asserted-by":"crossref","first-page":"e257","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.05.033","article-title":"Endovascular embolization of a nondominant vertebral artery compressed by an osteophyte to prevent recurrence of vertebrobasilar infarctions","volume":"24","author":"Thomas","year":"2015","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"4","key":"bib9-20250821","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.jvs.2012.12.044","article-title":"Bilateral mechanical rotational vertebral artery occlusion","volume":"58","author":"Dargon","year":"2013","journal-title":"J Vasc Surg"},{"issue":"1","key":"bib10-20250821","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s10143-011-0343-4","article-title":"Bow-hunter's syndrome caused by dynamic vertebral artery stenosis at the cranio-cervical junction\u2014a management algorithm based on a systematic review and a clinical series","volume":"35","author":"Cornelius","year":"2012","journal-title":"Neurosurg Rev"},{"issue":"4","key":"bib11-20250821","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1055\/s-0029-1239501","article-title":"Endovascular treatment for bow hunter's syndrome: case report","volume":"52","author":"Sugiu","year":"2009","journal-title":"Minim Invasive Neurosurg"}],"container-title":["Operative 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