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Intraoperative Ultrasound in Spinal Surgery

Intraoperative Ultrasound in Spinal Surgery

Published on: August 17, 2022

Intraoperative High-Resolution 2-Dimensional and 3-Dimensional Angiography in Cervical Decompression for Subaxial Bow

Awinita Barpujari¹, Erin N Walker¹, Om H Gandhi¹

¹Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

World Neurosurgery

|June 12, 2026

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Subaxial rotational occlusion syndrome, a form of Bow hunter's syndrome, can be effectively treated with anterior cervical decompression. Intraoperative angiography confirms vertebral artery patency, ensuring successful outcomes and symptom resolution.

Area of Science:

Neurosurgery
Vascular Surgery
Cervical Spine Surgery

Background:

Bow hunter's syndrome (BHS) involves vertebral artery (VA) compression during head rotation, causing vertebrobasilar insufficiency.
Subaxial cases of BHS, due to osteophytic V2 segment compression, lack standardized management.
Intraoperative confirmation of VA patency is crucial to prevent residual dynamic compression and reoperation.

Purpose of the Study:

To present two cases of subaxial rotational occlusion syndrome (subaxial BHS) managed with anterior cervical decompression.
To highlight the utility of intraoperative angiography in confirming VA patency after decompression.
To demonstrate the efficacy of this combined surgical approach for symptom resolution.

Main Methods:

Two patients with subaxial BHS underwent anterior cervical decompression of osteophytes compressing the VA.

Keywords:

Anterior cervical discectomy and fusion Bow Hunter's syndrome Hybrid operating room Intraoperative angiography Vertebral artery decompression

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Anterior cervical discectomy and fusion (ACDF) was performed to stabilize the cervical segment.

Intraoperative biplane and 3D rotational angiography were utilized to assess VA patency during simulated head turning.

Main Results:

Both patients experienced complete resolution of symptoms, including neck pain, dizziness, tinnitus, and visual disturbances.
Intraoperative angiography confirmed no dynamic compression and complete VA patency post-decompression and fusion.
Patients were discharged on postoperative day three with sustained symptom relief at six weeks.

Conclusions:

Anterior cervical decompression combined with intraoperative angiography is an effective treatment for subaxial rotational occlusion syndrome.
This approach ensures adequate decompression and confirms VA patency, leading to excellent clinical outcomes.
Standardized management for subaxial BHS can be achieved through this surgical technique.