{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:25:20Z","timestamp":1792027520514,"version":"4.4.0"},"reference-count":108,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,4]]},"abstract":"Rotational occlusion of the vertebral artery (VA), or bow hunter\u2019s syndrome, is a rare yet surgically treatable cause of vertebrobasilar insufficiency. The underlying pathology is dynamic stenosis of the VA by osteophytes, fibrous bands, or lateral disc herniation with neck rotation or extension. The authors present 2 previously unreported cases of bow hunter\u2019s syndrome and summarize 124 cases identified in a literature review.<\/jats:p>\n \n Both patients in the new cases were treated by VA decompression and fusion of the subaxial spine. Each had > 50% occlusion of the left VA at the point of entry into the transverse foramen with a contralateral VA that ended in the posterior inferior cerebellar artery. Analyzing data from 126 cases (the 2 new cases in addition to the previously published 124), the authors report that stenosis was noted within V\n 1<\/jats:sub>\n in 4% of cases, in V\n 2<\/jats:sub>\n in 58%, in V\n 3<\/jats:sub>\n in 36%, and distal to C-1 in 2%. Patients presented in the 5th to 7th decade of life and were more often male than female. The stenotic area was decompressed in 85 (73%) of the 116 patients for whom the type of treatment was reported (V\n 1<\/jats:sub>\n , 4 [80%] of 5; V\n 2<\/jats:sub>\n , 52 [83%] of 63; V\n 3<\/jats:sub>\n \/V\n 4<\/jats:sub>\n , 29 [60%] of 48). Less commonly, fusion or combined decompression and fusion was used (V\n 2<\/jats:sub>\n , 7 [11%] of 63; V\n 3<\/jats:sub>\n \/V\n 4<\/jats:sub>\n , 14 [29%] of 48). Most patients reported complete resolution of symptoms.\n <\/jats:p>\n The authors conclude that patients with bow hunter\u2019s syndrome classically have an impaired collateral blood flow to the brainstem. This condition carries an excellent prognosis with decompression, fusion, or combined surgery, and individual patient characteristics should guide the choice of therapy.<\/jats:p>","DOI":"10.3171\/2015.1.focus14791","type":"journal-article","created":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T13:05:25Z","timestamp":1427893525000},"page":"E7","source":"Crossref","is-referenced-by-count":94,"title":["Bow hunter\u2019s syndrome revisited: 2 new cases and literature review of 124 cases"],"prefix":"10.3171","volume":"38","author":[{"given":"Gregory F.","family":"Jost","sequence":"first","affiliation":[{"name":"Spine Surgery, University Hospital Basel, Switzerland; and"},{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Dailey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2 Suppl","key":"b1-focus14791","series-title":"J Neurosurg","first-page":"300","article-title":"Rotational compression of the vertebral artery at the point of dural penetration. Case report","volume":"93","author":"Akar","year":"2000"},{"key":"b2-focus14791","series-title":"J Neurosurg","first-page":"596","article-title":"Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis","volume":"23","author":"Bakay","year":"1965"},{"key":"b3-focus14791","series-title":"Arch Neurol","first-page":"119","article-title":"Arteriographic study of cere-brovascular disease. II. Cerebral symptoms due to kinking, tortuosity, and compression of carotid and vertebral arteries in the neck","volume":"4","author":"Bauer","year":"1961"},{"key":"b4-focus14791","series-title":"Surg Neurol","first-page":"625","article-title":"Rotational vertebral artery insufficiency resulting from cervical spondylosis: case report and review of the literature","volume":"65","author":"Bulsara","year":"2006"},{"key":"b5-focus14791","series-title":"J Korean Neurosurg Soc","first-page":"134","article-title":"Bow hunter\u2019s stroke caused by a severe facet hypertrophy of C1\u20132","volume":"47","author":"Chough","year":"2010"},{"key":"b6-focus14791","series-title":"Neurosurg Rev","first-page":"127","article-title":"Bow-hunter\u2019s syndrome caused by dynamic vertebral artery stenosis at the craniocervical junction\u2014a management algorithm based on a systematic review and a clinical series","volume":"35","author":"Cornelius","year":"2012"},{"key":"b7-focus14791","series-title":"J Neuroimaging","first-page":"184","article-title":"Rotational vertebrobasilar insufficiency due to dynamic compression of the dominant vertebral artery by the thyroid cartilage and occlusion of the contralateral vertebral artery at C1-2 level","volume":"18","author":"Dabus","year":"2008"},{"key":"b8-focus14791","series-title":"Acta Otolaryngol","first-page":"155","article-title":"Schwindelanf\u00e4lle und Nystagmus bei einer bestimmten Stellung des Kopfes","volume":"11","author":"De Kleyn","year":"1927"},{"key":"b9-focus14791","series-title":"South Med J","first-page":"871","article-title":"Positional compression of vertebral artery shown by magnetic resonance angiography","volume":"88","author":"DeMaria","year":"1995"},{"key":"b10-focus14791","series-title":"Bull Johns Hopkins Hosp","first-page":"168","article-title":"Syncope, vertigo and disturbances of vision resulting from intermittent obstruction of the vertebral arteries due to defect in the odontoid process and excessive mobility of the second cervical vertebra","volume":"91","author":"Ford","year":"1952"},{"key":"b11-focus14791","series-title":"J Neurosurg","first-page":"737","article-title":"Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery. Case report","volume":"83","author":"Fox","year":"1995"},{"key":"b12-focus14791","series-title":"Neurol Med Chir (Tokyo)","first-page":"1020","article-title":"Rotational stenosis of the first segment of the vertebral artery through compression by the cervical sympathetic chain\u2014case report","volume":"28","author":"Fujimoto","year":"1988"},{"key":"b13-focus14791","series-title":"Br Med J","first-page":"233","article-title":"Insufficiency of vertebral artery treated by decompression of its cervical part","volume":"2","author":"Gortvai","year":"1964"},{"key":"b14-focus14791","series-title":"Neurosurgery","first-page":"228","article-title":"Angiographic examination and surgical treatment of bow hunter\u2019s stroke","volume":"23","author":"Hanakita","year":"1988"},{"key":"b15-focus14791","series-title":"Arch Surg","first-page":"629","article-title":"Vertebral artery insufficiency produced by cervical osteoarthritic spurs","volume":"90","author":"Hardin","year":"1965"},{"key":"b16-focus14791","series-title":"Spine (Phila Pa 1976)","first-page":"E495","article-title":"Bow hunter\u2019s syndrome in the setting of contralateral vertebral artery stenosis: evaluation and treatment options","volume":"27","author":"Horowitz","year":"2002"},{"key":"b17-focus14791","series-title":"JAMA","first-page":"475","article-title":"Mechanical occlusion of the vertebral artery. A new clinical concept","volume":"196","author":"Husni","year":"1966"},{"key":"b18-focus14791","series-title":"World Neurosurg","first-page":"553.e15","article-title":"Posterior inferior cerebellar artery to posterior inferior cerebellar artery in situ bypass for the treatment of Bow Hunter\u2019s-type dynamic ischemia in holovertebral dissection","volume":"78","author":"Kan","year":"2012"},{"key":"b19-focus14791","series-title":"J Neurosurg","first-page":"1031","article-title":"Rotational occlusion of the vertebral artery caused by transverse process hyperrotation and unilateral apophyse-al joint subluxation. Case report","volume":"86","author":"Kawaguchi","year":"1997"},{"key":"b20-focus14791","series-title":"Spine J","first-page":"584","article-title":"Use of navigation-assisted fluoroscopy to decrease radiation exposure during minimally invasive spine surgery","volume":"8","author":"Kim","year":"2008"},{"key":"b21-focus14791","series-title":"Neurosurgery","first-page":"672","article-title":"Vertebral artery occlusion at the narrowed \u201cscalenovertebral angle\": mechanical vertebral occlusion in the distal first portion","volume":"16","author":"Kojima","year":"1985"},{"key":"b22-focus14791","series-title":"Neurosurgery","first-page":"1066","article-title":"Rotational vertebral artery occlusion-series of 9 cases","volume":"67","author":"Lu","year":"2010"},{"key":"b23-focus14791","series-title":"J Neurosurg","first-page":"581","article-title":"Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band. Case report","volume":"56","author":"Mapstone","year":"1982"},{"key":"b24-focus14791","series-title":"Neurosurgery","first-page":"1393","article-title":"Bow Hunter\u2019s stroke caused by a nondominant vertebral artery occlusion: case report","volume":"41","author":"Matsuyama","year":"1997"},{"key":"b25-focus14791","series-title":"J Neurosurg","first-page":"619","article-title":"Comparison of C1-2 posterior fusion and decompression of the vertebral artery in the treatment of bow hunter\u2019s stroke","volume":"86","author":"Matsuyama","year":"1997"},{"key":"b26-focus14791","series-title":"Spine (Phila Pa 1976)","first-page":"E366","article-title":"Subaxial positional vertebral artery occlusion corrected by decompression and fusion","volume":"33","author":"Miele","year":"2008"},{"key":"b27-focus14791","series-title":"J Neurosurg","first-page":"507","article-title":"Rotational obstruction of nondominant vertebral artery and ischemia. Case report","volume":"85","author":"Morimoto","year":"1996"},{"key":"b28-focus14791","series-title":"J Neurosurg","first-page":"512","article-title":"Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis","volume":"32","author":"Nagashima","year":"1970"},{"key":"b29-focus14791","series-title":"Vasc Med","first-page":"265","article-title":"Rotational vertebrobasilar ischemia due to vertebral artery dynamic stenoses complicated by an ostial atherosclerotic stenosis","volume":"14","author":"Natello","year":"2009"},{"issue":"1 Suppl","key":"b30-focus14791","series-title":"J Neurosurg","first-page":"80","article-title":"Transient rotational compression of the vertebral artery caused by herniated cervical disc. Case report","volume":"98","author":"Nemecek","year":"2003"},{"key":"b31-focus14791","series-title":"Zentralbl Neurochir","first-page":"217","article-title":"Symptomatic rotational occlusion of the vertebral artery\u2014case report and review of the literature","volume":"66","author":"Netuka","year":"2005"},{"key":"b32-focus14791","series-title":"Clin Neurol Neurosurg","first-page":"250","article-title":"Proper management of the rotational vertebral artery occlusion secondary to spondylosis","volume":"103","author":"Ogino","year":"2001"},{"key":"b33-focus14791","series-title":"Acta Neurochir (Wien)","first-page":"391","article-title":"Vertebral artery decompression in a patient with rotational occlusion","volume":"150","author":"Petridis","year":"2008"},{"key":"b34-focus14791","series-title":"Br J Neurosurg","first-page":"361","article-title":"Craniovertebral junction malformation and rotational occlusion of the vertebral artery","volume":"14","author":"Puca","year":"2000"},{"key":"b35-focus14791","series-title":"Arch Neurol","first-page":"8","article-title":"Variation in form of circle of Willis. The relation of the variations to collateral circulation: anatomic analysis","volume":"8","author":"Riggs","year":"1963"},{"key":"b36-focus14791","series-title":"J Neurosurg","first-page":"111","article-title":"Rheumatoid arthritis and positional vertebrobasilar insufficiency. Case report","volume":"65","author":"Robinson","year":"1986"},{"key":"b37-focus14791","series-title":"Neurol Med Chir (Tokyo)","first-page":"696","article-title":"Bow hunter\u2019s stroke associated with at-lantooccipital assimilation\u2014case report","volume":"39","author":"Sakai","year":"1999"},{"key":"b38-focus14791","series-title":"Neurosurgery","first-page":"1474","article-title":"Anterior decompression of the atlantoaxial vertebral artery to treat bow hunter\u2019s stroke: technical case report","volume":"49","author":"Seki","year":"2001"},{"key":"b39-focus14791","series-title":"J Neurosurg","first-page":"617","article-title":"Rotational vertebrobasilar insufficiency as a component of thoracic outlet syndrome resulting in transient blindness. Case report","volume":"81","author":"Sell","year":"1994"},{"key":"b40-focus14791","series-title":"Neurology","first-page":"968","article-title":"Vertebral artery compression in cervical spondylosis: arteriographic demonstration during life of vertebral artery insufficiency due to rotation and extension of the neck","volume":"10","author":"Sheehan","year":"1960"},{"key":"b41-focus14791","series-title":"J Neurosurg","first-page":"127","article-title":"Decompression of the vertebral artery for bow-hunter\u2019s stroke. Case report","volume":"69","author":"Shimizu","year":"1988"},{"key":"b42-focus14791","series-title":"J Neurol Neurosurg Psychiatry","first-page":"388","article-title":"Cervical spondylosis causing vertebrobasilar insufficiency: a surgical treatment","volume":"34","author":"Smith","year":"1971"},{"key":"b43-focus14791","series-title":"Neurosurgery","first-page":"259","article-title":"Bow hunter\u2019s stroke","volume":"2","author":"Sorensen","year":"1978"},{"key":"b44-focus14791","series-title":"Stroke","first-page":"1776","article-title":"Dynamic transcranial Doppler assessment of positional vertebrobasilar ischemia","volume":"25","author":"Sturzenegger","year":"1994"},{"key":"b45-focus14791","series-title":"Minim Invasive Neurosurg","first-page":"193","article-title":"Endovascular treatment for bow hunter\u2019s syndrome: case report","volume":"52","author":"Sugiu","year":"2009"},{"key":"b46-focus14791","series-title":"Arch Neurol","first-page":"616","article-title":"Influence of head position upon cerebral circulation. Studies on blood flow in cadavers","volume":"2","author":"Toole","year":"1960"},{"key":"b47-focus14791","series-title":"Neurol Med Chir (Tokyo)","first-page":"90","article-title":"Simultaneous bilateral vertebral artery occlusion in the lower cervical spine manifesting as bow hunter\u2019s syndrome","volume":"48","author":"Tsutsumi","year":"2008"},{"key":"b48-focus14791","series-title":"J Neurosurg Spine","first-page":"326","article-title":"Positional vertebral artery compression and vertebrobasilar insufficiency due to a herniated cervical disc","volume":"11","author":"Ujifuku","year":"2009"},{"issue":"1 Suppl","key":"b49-focus14791","series-title":"J Neurosurg","first-page":"90","article-title":"Bow hunter stroke caused by cervical disc herniation. Case report","volume":"96","author":"Vates","year":"2002"},{"key":"b50-focus14791","series-title":"Surg Neurol","first-page":"420","article-title":"Intraoperative dynamic angiography to detect resolution of Bow Hunter\u2019s syndrome: technical case report","volume":"66","author":"Velat","year":"2006"},{"key":"b51-focus14791","series-title":"Neurosurgery","first-page":"36","article-title":"Rotational vertebrobasilar ischemia: hemodynamic assessment and surgical treatment","volume":"56","author":"Vilela","year":"2005"},{"key":"b52-focus14791","series-title":"J Neurol Sci","first-page":"87","article-title":"Ischemic symptoms induced by occlusion of the unilateral vertebral artery with head rotation together with contralateral vertebral artery dissection\u2014case report","volume":"236","author":"Wakayama","year":"2005"},{"key":"b53-focus14791","series-title":"Surg Neurol","first-page":"169","article-title":"Bow hunter\u2019s syndrome caused by accessory cervical ossification: posterolateral decompression and the use of intraoperative Doppler ultrasonography","volume":"67","author":"Whitmore","year":"2007"},{"key":"b54-focus14791","series-title":"AJNR Am J Neuroradiol","first-page":"96","article-title":"Rotational vertebral artery occlusion at C1\u2013C2","volume":"6","author":"Yang","year":"1985"},{"issue":"2 Suppl","key":"b1-focus14791","series-title":"J Neurosurg","first-page":"300","article-title":"Rotational compression of the vertebral artery at the point of dural penetration. Case report","volume":"93","author":"Akar","year":"2000"},{"key":"b2-focus14791","series-title":"J Neurosurg","first-page":"596","article-title":"Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis","volume":"23","author":"Bakay","year":"1965"},{"key":"b3-focus14791","series-title":"Arch Neurol","first-page":"119","article-title":"Arteriographic study of cere-brovascular disease. II. Cerebral symptoms due to kinking, tortuosity, and compression of carotid and vertebral arteries in the neck","volume":"4","author":"Bauer","year":"1961"},{"key":"b4-focus14791","series-title":"Surg Neurol","first-page":"625","article-title":"Rotational vertebral artery insufficiency resulting from cervical spondylosis: case report and review of the literature","volume":"65","author":"Bulsara","year":"2006"},{"key":"b5-focus14791","series-title":"J Korean Neurosurg Soc","first-page":"134","article-title":"Bow hunter\u2019s stroke caused by a severe facet hypertrophy of C1\u20132","volume":"47","author":"Chough","year":"2010"},{"key":"b6-focus14791","series-title":"Neurosurg Rev","first-page":"127","article-title":"Bow-hunter\u2019s syndrome caused by dynamic vertebral artery stenosis at the craniocervical junction\u2014a management algorithm based on a systematic review and a clinical series","volume":"35","author":"Cornelius","year":"2012"},{"key":"b7-focus14791","series-title":"J Neuroimaging","first-page":"184","article-title":"Rotational vertebrobasilar insufficiency due to dynamic compression of the dominant vertebral artery by the thyroid cartilage and occlusion of the contralateral vertebral artery at C1-2 level","volume":"18","author":"Dabus","year":"2008"},{"key":"b8-focus14791","series-title":"Acta Otolaryngol","first-page":"155","article-title":"Schwindelanf\u00e4lle und Nystagmus bei einer bestimmten Stellung des Kopfes","volume":"11","author":"De Kleyn","year":"1927"},{"key":"b9-focus14791","series-title":"South Med J","first-page":"871","article-title":"Positional compression of vertebral artery shown by magnetic resonance angiography","volume":"88","author":"DeMaria","year":"1995"},{"key":"b10-focus14791","series-title":"Bull Johns Hopkins Hosp","first-page":"168","article-title":"Syncope, vertigo and disturbances of vision resulting from intermittent obstruction of the vertebral arteries due to defect in the odontoid process and excessive mobility of the second cervical vertebra","volume":"91","author":"Ford","year":"1952"},{"key":"b11-focus14791","series-title":"J Neurosurg","first-page":"737","article-title":"Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery. Case report","volume":"83","author":"Fox","year":"1995"},{"key":"b12-focus14791","series-title":"Neurol Med Chir (Tokyo)","first-page":"1020","article-title":"Rotational stenosis of the first segment of the vertebral artery through compression by the cervical sympathetic chain\u2014case report","volume":"28","author":"Fujimoto","year":"1988"},{"key":"b13-focus14791","series-title":"Br Med J","first-page":"233","article-title":"Insufficiency of vertebral artery treated by decompression of its cervical part","volume":"2","author":"Gortvai","year":"1964"},{"key":"b14-focus14791","series-title":"Neurosurgery","first-page":"228","article-title":"Angiographic examination and surgical treatment of bow hunter\u2019s stroke","volume":"23","author":"Hanakita","year":"1988"},{"key":"b15-focus14791","series-title":"Arch Surg","first-page":"629","article-title":"Vertebral artery insufficiency produced by cervical osteoarthritic spurs","volume":"90","author":"Hardin","year":"1965"},{"key":"b16-focus14791","series-title":"Spine (Phila Pa 1976)","first-page":"E495","article-title":"Bow hunter\u2019s syndrome in the setting of contralateral vertebral artery stenosis: evaluation and treatment options","volume":"27","author":"Horowitz","year":"2002"},{"key":"b17-focus14791","series-title":"JAMA","first-page":"475","article-title":"Mechanical occlusion of the vertebral artery. A new clinical concept","volume":"196","author":"Husni","year":"1966"},{"key":"b18-focus14791","series-title":"World Neurosurg","first-page":"553.e15","article-title":"Posterior inferior cerebellar artery to posterior inferior cerebellar artery in situ bypass for the treatment of Bow Hunter\u2019s-type dynamic ischemia in holovertebral dissection","volume":"78","author":"Kan","year":"2012"},{"key":"b19-focus14791","series-title":"J Neurosurg","first-page":"1031","article-title":"Rotational occlusion of the vertebral artery caused by transverse process hyperrotation and unilateral apophyse-al joint subluxation. Case report","volume":"86","author":"Kawaguchi","year":"1997"},{"key":"b20-focus14791","series-title":"Spine J","first-page":"584","article-title":"Use of navigation-assisted fluoroscopy to decrease radiation exposure during minimally invasive spine surgery","volume":"8","author":"Kim","year":"2008"},{"key":"b21-focus14791","series-title":"Neurosurgery","first-page":"672","article-title":"Vertebral artery occlusion at the narrowed \u201cscalenovertebral angle\": mechanical vertebral occlusion in the distal first portion","volume":"16","author":"Kojima","year":"1985"},{"key":"b22-focus14791","series-title":"Neurosurgery","first-page":"1066","article-title":"Rotational vertebral artery occlusion-series of 9 cases","volume":"67","author":"Lu","year":"2010"},{"key":"b23-focus14791","series-title":"J Neurosurg","first-page":"581","article-title":"Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band. Case report","volume":"56","author":"Mapstone","year":"1982"},{"key":"b24-focus14791","series-title":"Neurosurgery","first-page":"1393","article-title":"Bow Hunter\u2019s stroke caused by a nondominant vertebral artery occlusion: case report","volume":"41","author":"Matsuyama","year":"1997"},{"key":"b25-focus14791","series-title":"J Neurosurg","first-page":"619","article-title":"Comparison of C1-2 posterior fusion and decompression of the vertebral artery in the treatment of bow hunter\u2019s stroke","volume":"86","author":"Matsuyama","year":"1997"},{"key":"b26-focus14791","series-title":"Spine (Phila Pa 1976)","first-page":"E366","article-title":"Subaxial positional vertebral artery occlusion corrected by decompression and fusion","volume":"33","author":"Miele","year":"2008"},{"key":"b27-focus14791","series-title":"J Neurosurg","first-page":"507","article-title":"Rotational obstruction of nondominant vertebral artery and ischemia. Case report","volume":"85","author":"Morimoto","year":"1996"},{"key":"b28-focus14791","series-title":"J Neurosurg","first-page":"512","article-title":"Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis","volume":"32","author":"Nagashima","year":"1970"},{"key":"b29-focus14791","series-title":"Vasc Med","first-page":"265","article-title":"Rotational vertebrobasilar ischemia due to vertebral artery dynamic stenoses complicated by an ostial atherosclerotic stenosis","volume":"14","author":"Natello","year":"2009"},{"issue":"1 Suppl","key":"b30-focus14791","series-title":"J Neurosurg","first-page":"80","article-title":"Transient rotational compression of the vertebral artery caused by herniated cervical disc. Case report","volume":"98","author":"Nemecek","year":"2003"},{"key":"b31-focus14791","series-title":"Zentralbl Neurochir","first-page":"217","article-title":"Symptomatic rotational occlusion of the vertebral artery\u2014case report and review of the literature","volume":"66","author":"Netuka","year":"2005"},{"key":"b32-focus14791","series-title":"Clin Neurol Neurosurg","first-page":"250","article-title":"Proper management of the rotational vertebral artery occlusion secondary to spondylosis","volume":"103","author":"Ogino","year":"2001"},{"key":"b33-focus14791","series-title":"Acta Neurochir (Wien)","first-page":"391","article-title":"Vertebral artery decompression in a patient with rotational occlusion","volume":"150","author":"Petridis","year":"2008"},{"key":"b34-focus14791","series-title":"Br J Neurosurg","first-page":"361","article-title":"Craniovertebral junction malformation and rotational occlusion of the vertebral artery","volume":"14","author":"Puca","year":"2000"},{"key":"b35-focus14791","series-title":"Arch Neurol","first-page":"8","article-title":"Variation in form of circle of Willis. The relation of the variations to collateral circulation: anatomic analysis","volume":"8","author":"Riggs","year":"1963"},{"key":"b36-focus14791","series-title":"J Neurosurg","first-page":"111","article-title":"Rheumatoid arthritis and positional vertebrobasilar insufficiency. Case report","volume":"65","author":"Robinson","year":"1986"},{"key":"b37-focus14791","series-title":"Neurol Med Chir (Tokyo)","first-page":"696","article-title":"Bow hunter\u2019s stroke associated with at-lantooccipital assimilation\u2014case report","volume":"39","author":"Sakai","year":"1999"},{"key":"b38-focus14791","series-title":"Neurosurgery","first-page":"1474","article-title":"Anterior decompression of the atlantoaxial vertebral artery to treat bow hunter\u2019s stroke: technical case report","volume":"49","author":"Seki","year":"2001"},{"key":"b39-focus14791","series-title":"J Neurosurg","first-page":"617","article-title":"Rotational vertebrobasilar insufficiency as a component of thoracic outlet syndrome resulting in transient blindness. Case report","volume":"81","author":"Sell","year":"1994"},{"key":"b40-focus14791","series-title":"Neurology","first-page":"968","article-title":"Vertebral artery compression in cervical spondylosis: arteriographic demonstration during life of vertebral artery insufficiency due to rotation and extension of the neck","volume":"10","author":"Sheehan","year":"1960"},{"key":"b41-focus14791","series-title":"J Neurosurg","first-page":"127","article-title":"Decompression of the vertebral artery for bow-hunter\u2019s stroke. 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