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Choi JW, Qiao Y, Mehta TI, Wilson JN, Torigoe TH, Tsappidi S, Jonathan Zhang Y, Brown SC, Hui FK, Abruzzo T. Safety and efficacy of dynamic catheter-directed cerebral digital subtraction angiography for diagnosis of bowhunter syndrome spectrum disorders: A systematic review of the literature. Interv Neuroradiol 2024:15910199241236820. [PMID: 38477583 DOI: 10.1177/15910199241236820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Dynamic catheter-directed cerebral digital subtraction angiography (dcDSA) is the gold standard for diagnosing dynamic vascular occlusion syndromes such as bowhunter syndrome (BHS). Nonetheless, concerns about its safety exist and no standardized protocols have been published to date. METHODS We describe our methodology and insights regarding the use of dcDSA in patients with BHS. We also perform a systematic literature review to identify cases of typical and atypical presentations of BHS wherein dcDSA was utilized and report on any procedural complications related to dcDSA. RESULTS Our study included 104 cases wherein dcDSA was used for the diagnosis of BHS. There were 0 reported complications of dcDSA. DcDSA successfully established diagnosis in 102 of these cases. Thirty-eight cases were deemed atypical presentations of BHS. Fourteen patients endorsed symptoms during neck flexion/extension. In eight cases, there was dynamic occlusion of bilateral vertebral arteries during a single maneuver. Three patients had multiple areas of occlusion along a single vertebral artery (VA). An anomalous entry of the VA above the C6 transverse foramen was observed in four patients. One patient had VA occlusion with neutral head position and recanalization upon contralateral lateral head tilt. CONCLUSION Our study highlights the safety and diagnostic benefits of dcDSA in characterizing the broad spectrum of BHS pathology encountered in clinical practice. This technique offers a powerful means to evaluate changes in cerebral blood flow and cervical arterial morphology in real time, overcoming the constraints of static imaging methods. Our findings pave the way for further studies on dcDSA to enhance cross-sectional imaging methods for the characterization of BHS and other dynamic vascular occlusion syndromes.
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Affiliation(s)
- Joo Won Choi
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Yang Qiao
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, Houston, TX, USA
| | - Tej I Mehta
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jessica N Wilson
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Trevor H Torigoe
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Samuel Tsappidi
- Department of Neurointerventional Surgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Y Jonathan Zhang
- Department of Neurointerventional Surgery, The Queen's Medical Center, Honolulu, HI, USA
- Department of Neurosurgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Stacy C Brown
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Neuroscience Institute, The Queen's Medical Center, Honolulu, HI, USA
| | - Ferdinand K Hui
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Department of Neurointerventional Surgery, The Queen's Medical Center, Honolulu, HI, USA
- Neuroscience Institute, The Queen's Medical Center, Honolulu, HI, USA
| | - Todd Abruzzo
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
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Ahn JH, Jun HS, Kim IK, Kim CH, Lee SJ. Atypical case of bow hunter's syndrome linked to aberrantly coursing vertebral artery: A case report. World J Clin Cases 2023; 11:8399-8403. [PMID: 38130620 PMCID: PMC10731192 DOI: 10.12998/wjcc.v11.i35.8399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND In bow hunter's syndrome (BHS), also known as rotational vertebral artery (VA) syndrome, there is dynamic/rotational compression of the VA producing vertebrobasilar insufficiency. Most occurrences involve atlantoaxial rather than mid-cervical VA compromise, the latter being rarely reported. Herein, we detail successful VA decompression at mid-cervical spine, given a departure from its usual course. CASE SUMMARY The patient, a 45-year-old man, presented to our hospital with occipital headache and vertigo. Computed tomography angiography showed anomalous C4 entry of right VA, with compression upon head rotation to that side. Thyroid cartilage and anterior tubercle of C5 transverse process were visibly at fault. We opted for surgery, using an anterior cervical approach to remove the anterior tubercle. Patient recovery was uneventful and brought resolution of all preoperative symptoms. CONCLUSION BHS is an important consideration where aberrant coursing of VA and neurologic symptoms coexist.
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Affiliation(s)
- Jun Hyong Ahn
- Department of Neurosurgery, Kangwon National University School of Medicine, Kangwon National University Hospital, Gangwon-do, Chuncheon-si 24289, South Korea
| | - Hyo Sub Jun
- Department of Neurosurgery, Kangwon National University School of Medicine, Kangwon National University Hospital, Gangwon-do, Chuncheon-si 24289, South Korea
| | - In Kyeong Kim
- Department of Neurosurgery, Kangwon National University School of Medicine, Kangwon National University Hospital, Gangwon-do, Chuncheon-si 24289, South Korea
| | - Choong Hyo Kim
- Department of Neurosurgery, Kangwon National University School of Medicine, Kangwon National University Hospital, Gangwon-do, Chuncheon-si 24289, South Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University School of Medicine, Kangwon National University Hospital, Gangwon-do, Chuncheon-si 24289, South Korea
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Sühs KW, Koestner W, Schütze M, Bronzlik P, Hermann EJ, Durisin M, Polemikos M, Krauss JK, Höglinger GU. Recurrent infarcts from thyroid cartilage compression of an aberrant vertebral artery: rare, easily overlooked, but treatable. J Neurol 2023; 270:6146-6150. [PMID: 37548680 PMCID: PMC10632289 DOI: 10.1007/s00415-023-11896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Affiliation(s)
- K W Sühs
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - W Koestner
- Department of Radiology and Neuroradiology, St. Bernward Hospital, Treibestraße 9, 31134, Hildesheim, Germany.
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany.
| | - M Schütze
- Department of Radiology and Neuroradiology, St. Bernward Hospital, Treibestraße 9, 31134, Hildesheim, Germany
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - P Bronzlik
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - E J Hermann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - M Durisin
- Department of Otolaryngology, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - M Polemikos
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - J K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - G U Höglinger
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
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Spence RN, Shumrick C, Tarro J. Compression of the Vertebral Artery by the Thyroid Cartilage Causing Vertebrobasilar Insufficiency. Laryngoscope 2023; 133:1214-1217. [PMID: 36692182 DOI: 10.1002/lary.30582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/02/2022] [Accepted: 01/01/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND This retrospective case report describes a rare presentation of VBI in a young male patient. AIMS Share a rare cause of VBI in a young patient. MATERIALS & METHODS The patient presented with recurrent episodes of dizziness and a history of several cerebellar infarcts. Imaging revealed the right vertebral artery was being mechanically compressed by the right superior cornu of the thyroid cartilage during mouth opening. Surgical resection of the right superior cornu of the thyroid cartilage was performed. RESULTS Intraoperative angiography revealed a right vertebral artery without compression during mouth opening. DISCUSSION Clinicians should consider the thyroid cartilage as a potential source of recurrent VBI due to mechanical compression of the VA. CONCLUSION Resection of the causative portion of the thyroid cartilage resolved the compression in this case, and should be employed in similar cases. Laryngoscope, 2023.
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Affiliation(s)
- Ryland N Spence
- Division of ENT/Head and Neck Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher Shumrick
- Department of Otolaryngology Head and Neck Surgery, Tufts University Medical Center, Boston, Massachusetts, USA
| | - John Tarro
- Rhode Island ENT Physicians, Inc., Providence, Rhode Island, USA
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Hong X, D'heygere E, Prisman E. Thyroid Cartilage Compression Causing Bow Hunter's Syndrome. Ann Otol Rhinol Laryngol 2022; 132:105-109. [PMID: 35152775 DOI: 10.1177/00034894221077477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES AND METHODS We report a unique case of Bow Hunter's syndrome with a dominant aberrantly coursing right vertebral artery (VA), presenting with persistent dizziness and syncope despite previous decompressive surgery at vertebral levels C5-C6. RESULTS Re-evaluation with computed tomography-scan during provocation of dizziness by neck rotation revealed compression of the right VA at level C6 from against the ipsilateral posterior border and superior cornu of the thyroid cartilage. Laryngoplasty resulted in complete resolution of symptoms. CONCLUSION This extremely rare cause of Bow's Hunter's syndrome should be considered, especially in refractory cases after neurosurgical decompression, and surgical management is straightforward and successful.
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Affiliation(s)
- Xinyuan Hong
- Division of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Emmanuel D'heygere
- Division of Otolaryngology, Head and Neck Surgery, AZ Groeninge, Kortrijk, West-Vlaanderen, Belgium
| | - Eitan Prisman
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
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Bukhari MK, Alghamdi SA. Ischemic Stroke Secondary to Dynamic Vertebral Artery Stenosis: Case Report and Review of the Literature. Cureus 2021; 13:e20167. [PMID: 35003995 PMCID: PMC8724019 DOI: 10.7759/cureus.20167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/24/2022] Open
Abstract
Ischemic stroke secondary to dynamic vertebral artery stenosis or occlusion, also known as “bow hunter's syndrome,” is a rare stroke mechanism. We report a case of a 24-year-old man with multiple hereditary exostosis (MHE) diagnosed at childhood. His first presentation to a neurologist was due to neck pain and clinical syndrome suggestive of ischemia in the vertebrobasilar territory. A therapeutic occlusion was done successfully without complication. The patient was discharged two days later on aspirin alone. In follow up one year later he continued to be symptom free. Moreover, this stroke mechanism has been reported extensively in the literature in isolation or secondary to many underlying diseases. In total, there are 168 cases reported in the published English literature, in either case reports or small series. In this review, we found that by far, vertebral artery occlusion at the atlanto-axial (C1-2) level dominated most reported cases. The most frequent presentation that led to further investigation was syncope or pre-syncope provoked by head rotation to one side. To our knowledge, there is no previous report of any stroke syndrome related to MHE before our case. In this paper, we report the first case secondary to MHE and review the literature up to date since the first reported case in 1952.
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Han CY, Long SM, Parikh NS, Phillips CD, Obayemi A, Yu VX, Banuchi V. Impingement of the Thyroid Cartilage on the Carotid Causing Clicking Larynx Syndrome and Stroke. Laryngoscope 2021; 132:1410-1413. [PMID: 34825720 DOI: 10.1002/lary.29956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/12/2021] [Indexed: 11/09/2022]
Abstract
We present the case of a patient with a recent history of ischemic stroke who presented with clicking larynx syndrome, a condition in which clicking noises in the larynx can be provoked by movement of the head and neck. Diagnostic imaging revealed unusual development and posterior angulation of the superior horn of the thyroid cartilage that potentially was causing trauma to the left common carotid artery. We deduced that symptomatic impingement of the carotid artery by the thyroid cartilage was not only the cause of the patient's clicking larynx syndrome, but also suspected to be the cause of her prior strokes due to repetitive trauma resulting in thrombus. The patient was managed surgically with thyroplasty and transcervical resection of the left greater cornu of the thyroid cartilage with resolution of her symptoms. Anatomical displacement of the thyroid cartilage can manifest as clicking larynx syndrome as well as cause mechanical injury to the carotid artery, resulting in turbulent flow, possible thrombosis, and stroke. Laryngoscope, 2021.
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Affiliation(s)
| | - Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Neal S Parikh
- Department of Neurology, Weill Cornell Medicine, New York, New York, U.S.A
| | - C Douglas Phillips
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, New York, U.S.A
| | - Adetokunbo Obayemi
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Victoria X Yu
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Victoria Banuchi
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
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Jongbloed W, Gertel A, Kashat L, Singh R, Parham K. Vertebral Artery Compression by the Greater Cornu of the Thyroid Cartilage. EAR, NOSE & THROAT JOURNAL 2021; 102:301-303. [PMID: 33759595 DOI: 10.1177/01455613211002921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A case of symptomatic unilateral vertebral artery compression by the greater cornu of the thyroid cartilage is described. Imaging shows ossification of the greater cornu of the thyroid cartilage with compression of an aberrant vertebral artery that enters the transverse foramen at the level of C4. Diagnostic workup and surgical treatment are described. Laryngoplasty with a transverse cervical approach and resection of the greater cornu of the thyroid cartilage resulted in resolution of symptoms.
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Affiliation(s)
- Walter Jongbloed
- 12227University of Connecticut School of Medicine, Farmington, CT, USA
| | - Alexander Gertel
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 21654University of Connecticut Heath Center, Farmington, CT, USA
| | - Lawrence Kashat
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 21654University of Connecticut Heath Center, Farmington, CT, USA
| | - Roshansa Singh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 21654University of Connecticut Heath Center, Farmington, CT, USA
| | - Kourosh Parham
- 12227University of Connecticut School of Medicine, Farmington, CT, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 21654University of Connecticut Heath Center, Farmington, CT, USA
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ISHIKAWA T, MORIBE K, ITO K, KABEYA R. Carotid Endarterectomy Requiring Removal of the Superior Horn of Thyroid Cartilage: Case Report and Literature Review. NMC Case Rep J 2021; 8:595-600. [PMID: 35079522 PMCID: PMC8769441 DOI: 10.2176/nmccrj.cr.2020-0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/02/2021] [Indexed: 11/20/2022] Open
Abstract
Carotid endarterectomy (CEA) is an established surgical procedure for carotid stenosis. We present the case of a 74-year-old man who underwent CEA for symptomatic internal carotid artery (ICA) stenosis. During the operation, we found that the hyoid bone (HB) and the superior horn of the thyroid cartilage covered the carotid sheath, preventing adequate visualization. Since this was anticipated based on preoperative examinations, the superior horn of thyroid cartilage was removed with the help of an otorhinolaryngologist. The HB was preserved because it could be retracted, and thereafter we performed CEA. Although CEA is a common procedure, the HB and thyroid cartilage are rarely involved in the operation. We present a case report including literature review of acute cerebrovascular syndrome (ACVS) due to HB and thyroid cartilage obstruction.
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Affiliation(s)
- Takayuki ISHIKAWA
- Department of Neurosurgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan
| | - Kazuho MORIBE
- Department of Otorhinolaryngology, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan
| | - Keishi ITO
- Department of Neurosurgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan
| | - Ryusuke KABEYA
- Department of Neurosurgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan
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O'Connor KP, Smitherman AD, Palejwala AH, Krempl GA, Martin MD. Anterior cervical discectomy and fusion requiring resection of the superior horn of thyroid cartilage: case report. J Neurosurg Spine 2019; 32:559-561. [PMID: 31812135 DOI: 10.3171/2019.9.spine19158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 09/23/2019] [Indexed: 11/06/2022]
Abstract
Anterior cervical discectomy and fusion (ACDF) is the most common surgical procedure utilized for degenerative diseases of the cervical spine. The authors present the case of a 64-year-old man who underwent an ACDF for degenerative changes causing cervical stenosis with myelopathy. The patient's symptoms consisted of pain and weakness of the bilateral upper extremities that slowly progressed over 1.5 years. During the procedure, the superior horn of the thyroid cartilage impeded proper retraction, preventing adequate visualization due to its prominent size. At this point, otorhinolaryngology was consulted, which allowed for safe resection of this portion of the thyroid cartilage while preserving nearby critical structures. With the frequent usage of this surgical approach for various etiologies, the importance of proper recognition and consultation is paramount. Encountering prominent thyroid cartilage resulting in surgical obstruction has not been described in the literature and this report represents a paradigm for the proper course of action.
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Affiliation(s)
| | | | | | - Greg A Krempl
- 2Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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