Ｂｏｗ　ｈｕｎｔｅｒ　ｓｔｒｏｋｅの外科治療

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  • Surgical Taeatments for Bow Hunter Stroke

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Bow hunter stroke is a symptomatic vertebrobasilar insufficiency caused by stenosis or occlusion of the vertebral artery at the C1-C2 level on head rotation. The appearance of the symptom affects the patient’s ADL, and occasionally it causes cerebral infarction in the cerebellum or brain stem. When conservative treatment is not effective, surgical treatment becomes necessary. Two techniques are known: C1-C2 posterior fusion and decompression of the vertebral artery, but which technique is better remains controversial. <br> We describe 21 cases of Bow hunter stroke. In 21 cases, decompression of the vertebral artery was performed in 9 cases, and C1-C2 posterior fusion was performed in 12 cases. We compared the results of the 2 techniques in relation to recurrence of clinical symptoms, complications, and ADL after treatment. In groups treated by posterior fusion, the range of head motion was reduced, but there was no postoperative recurrence of clinical symptom or disturbance of ADL. On the other hand, in groups treated by decompression of the vertebral artery, there was no limitation of head motion, but in 3 cases clinical symptoms recurred. In 2 of the 3, it was necessary to add C1-C2 posterior fusion. In 1 of the 3, brain stem infarction occurred. All events occurred within 3 months after operation. In 2 cases of added posterior fusion, symptoms did not recur. Decompression of the vertebral artery may cause recurrence of the symptom within 3 months after surgery because of formation of adhesions of the vertebral artery to surrounding structures, which is impossible to predict or prevent.<br> Therefore, we conclude that C1-C2 posterior fusion is more useful than decompression of the vertebral artery.<br>

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  • 脳卒中の外科

    脳卒中の外科 38 (3), 174-180, 2010

    一般社団法人 日本脳卒中の外科学会

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