{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:54:37Z","timestamp":1782867277264,"version":"3.54.5"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"26","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,6,29]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Acute vertebrobasilar occlusion is most commonly thromboembolic and requires emergency endovascular therapy (EVT). However, upper cervical instability may rarely cause neck motion-dependent dynamic vertebral artery (VA) occlusion. Os odontoideum is a recognized cause of atlantoaxial instability that has been associated with bow hunter syndrome; however, acute bilateral VA occlusion mimicking basilar artery occlusion (BAO) is exceedingly uncommon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 73-year-old man with recurrent posterior circulation infarctions collapsed while golfing and rapidly progressed to coma with respiratory failure and quadriparesis. CT angiography demonstrated bilateral VA occlusion at the vertebrobasilar junction, and EVT was initiated for presumed BAO. Angiography revealed left VA occlusion at C1\u20132. After micro-guidewire passage, contrast stagnation at the lesion demonstrated to-and-fro flow extending to the left posterior inferior cerebellar artery. Full stent expansion with preserved aspiration backflow and repeated failure to retrieve the thrombus suggested a dynamic, nonthrombotic mechanism. Bone-window CT angiography identified os odontoideum with displacement and extension-dependent bilateral VA compromise. Durable VA patency was restored by cervical immobilization followed by occipitocervical fusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Persistent to-and-fro flow during EVT should raise the suspicion of dynamic occlusion. Disproportionate neurological decline, including hypoventilation, warrants evaluation for cervical instability requiring surgical stabilization.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26267\">https:\/\/thejns.org\/doi\/10.3171\/CASE26267<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26267","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:11:28Z","timestamp":1782864688000},"source":"Crossref","is-referenced-by-count":0,"title":["Dynamic bilateral vertebral artery occlusion owing to os odontoideum mimicking basilar artery occlusion: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9676-2248","authenticated-orcid":true,"given":"Takao","family":"Morita","sequence":"first","affiliation":[{"name":"Department of Neuroendovascular Therapy, National Hospital Organization Kyushu Medical Center, Fukuoka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Matsushita","sequence":"additional","affiliation":[{"name":"Department of Neuroendovascular Therapy, National Hospital Organization Kyushu Medical Center, Fukuoka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Okuda","sequence":"additional","affiliation":[{"name":"Department of Neuroendovascular Therapy, National Hospital Organization Kyushu Medical Center, Fukuoka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhito","family":"Ikeuchi","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5678-5623","authenticated-orcid":true,"given":"Tomoya","family":"Shibahara","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuo","family":"Kobara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Kuwashiro","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Sugimori","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So","family":"Tokunaga","sequence":"additional","affiliation":[{"name":"Department of Neuroendovascular Therapy, National Hospital Organization Kyushu Medical Center, Fukuoka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"15","key":"bib1","series-title":"N Engl J Med","first-page":"1361","article-title":"Trial of endovascular treatment of acute basilar-artery occlusion","volume":"387","author":"Tao","year":"2022","unstructured":"Tao CNogueira RGZhu YTrial of endovascular treatment of acute basilar-artery occlusion. N Engl J Med. 2022;387(15):1361-1372. doi:10.1056\/NEJMoa2206317"},{"issue":"3","key":"bib2","series-title":"Neurosurgery","first-page":"A22","article-title":"Os odontoideum: etiology and surgical management","volume":"66","author":"Arvin","year":"2010","unstructured":"Arvin BFournier-Gosselin MPFehlings MG.Os odontoideum: etiology and surgical management. Neurosurgery. 2010;66(3):A22-A31. doi:10.1227\/01.NEU.0000366113.15248.07"},{"issue":"3","key":"bib3","series-title":"J Craniovertebr Junction Spine","first-page":"256","article-title":"Os odontoideum: a comprehensive review","volume":"13","author":"Cho","year":"2022","unstructured":"Cho SShlobin NADahdaleh NS.Os odontoideum: a comprehensive review. J Craniovertebr Junction Spine. 2022;13(3):256-264. doi:10.4103\/jcvjs.jcvjs_71_22"},{"issue":"3","key":"bib4","series-title":"Neurosurgery","first-page":"259","article-title":"Bow hunter\u2019s stroke","volume":"2","author":"Sorensen","year":"1978","unstructured":"Sorensen BF.Bow hunter\u2019s stroke. Neurosurgery. 1978;2(3):259-261. doi:10.1227\/00006123-197805000-00013"},{"issue":"4","key":"bib5","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Bow hunter\u2019s syndrome revisited: 2 new cases and literature review of 124 cases","volume":"38","author":"Jost","year":"2015","unstructured":"Jost GFDailey AT.Bow hunter\u2019s syndrome revisited: 2 new cases and literature review of 124 cases. Neurosurg Focus. 2015;38(4):E7. doi:10.3171\/2015.1.FOCUS14791"},{"issue":"1","key":"bib6","series-title":"J Pediatr Orthop","first-page":"103","article-title":"Pediatric atlantoaxial instability presenting as cerebral and cerebellar infarcts","volume":"11","author":"Bhatnagar","year":"1991","unstructured":"Bhatnagar MSponseller PDCarroll CTolo VT.Pediatric atlantoaxial instability presenting as cerebral and cerebellar infarcts. 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Rinsho Shinkeigaku. 1991;31(10):1124-1128."},{"issue":"1","key":"bib17","series-title":"Stroke Vasc Interv Neurol","first-page":"e001303","article-title":"Unmasking the imitators: challenges in identifying intracranial atherosclerosis-related large vessel occlusion mimics during mechanical thrombectomy","volume":"5","author":"Rodriguez-Calienes","year":"2025","unstructured":"Rodriguez-Calienes ASiddiqui FMVivanco-Suarez JUnmasking the imitators: challenges in identifying intracranial atherosclerosis-related large vessel occlusion mimics during mechanical thrombectomy. Stroke Vasc Interv Neurol. 2025;5(1):e001303. doi:10.1161\/SVIN.123.001303"},{"issue":"10","key":"bib18","series-title":"Int J Med Sci","first-page":"2162","article-title":"New diagnostic algorithm for detection of covert bow hunter syndrome","volume":"18","author":"Kimihira","year":"2021","unstructured":"Kimihira LYoshimoto TIhara M.New diagnostic algorithm for detection of covert bow hunter syndrome. 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J Craniovertebr Junction Spine. 2022;13(3):256-264. doi:10.4103\/jcvjs.jcvjs_71_22"},{"issue":"3","key":"bib4","series-title":"Neurosurgery","first-page":"259","article-title":"Bow hunter\u2019s stroke","volume":"2","author":"Sorensen","year":"1978","unstructured":"Sorensen BF.Bow hunter\u2019s stroke. Neurosurgery. 1978;2(3):259-261. doi:10.1227\/00006123-197805000-00013"},{"issue":"4","key":"bib5","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Bow hunter\u2019s syndrome revisited: 2 new cases and literature review of 124 cases","volume":"38","author":"Jost","year":"2015","unstructured":"Jost GFDailey AT.Bow hunter\u2019s syndrome revisited: 2 new cases and literature review of 124 cases. 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J Pediatr Orthop. 1991;11(1):103-107. doi:10.1097\/01241398-199101000-00020"},{"issue":"11","key":"bib7","series-title":"Neurol Med Chir (Tokyo)","first-page":"769","article-title":"Bilateral vertebral artery occlusion secondary to atlantoaxial dislocation with os odontoideum: implication for prophylactic cervical stabilization by fusion\u2014case report","volume":"33","author":"Kikuchi","year":"1993","unstructured":"Kikuchi KNakagawa HWatanabe KKowada M.Bilateral vertebral artery occlusion secondary to atlantoaxial dislocation with os odontoideum: implication for prophylactic cervical stabilization by fusion\u2014case report. 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