A Case of Bow Hunter's Syndrome Caused by C3/4 Facet Joint Hypertrophy: Hemodynamic Complexity and Surgical Strategy

Satoka Shidoh; Katherine J. Jensen; Clayton L. Rosinski; Kathleen E. Dlouhy; Satoshi Yamaguchi

doi:10.2176/jns-nmc.2026-0089

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A Case of Bow Hunter's Syndrome Caused by C3/4 Facet Joint Hypertrophy: Hemodynamic Complexity and Surgical Strategy

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A Case of Bow Hunter's Syndrome Caused by C3/4 Facet Joint Hypertrophy: Hemodynamic Complexity and Surgical Strategy

Satoka Shidoh, Katherine J. Jensen, Clayton L. Rosinski, Kathleen E. Dlouhy and Satoshi Yamaguchi

NMC case report journal, Vol.13, pp.457-462

09/17/2026

DOI: 10.2176/jns-nmc.2026-0089

PMCID: PMC13668433

PMID: 42877945

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Abstract

Bow Hunter's syndrome results from rotational insufficiency of the vertebral artery. Though traditionally associated with C1-C2 level compression, subaxial cervical causes are increasingly recognized. We report a 68-year-old man with codominant vertebral arteries presenting with dizziness and transient visual disturbances during head rotation. Imaging showed severe focal stenosis caused by an osteophyte at the left C3-C4 facet joint. Dynamic angiography revealed that the left vertebral artery was nearly occluded during rotation; despite faint distal residual flow, contrast failed to reach the basilar artery. The patient underwent a left C3-C4 facetectomy and posterior C2-C5 fusion. Intraoperative angiography confirmed restoration of antegrade flow, and the patient's symptoms resolved postoperatively. Identifying the underlying hemodynamic mechanism and selecting an appropriate surgical route are important for the successful management of this condition.

Details

Title: Subtitle: A Case of Bow Hunter's Syndrome Caused by C3/4 Facet Joint Hypertrophy: Hemodynamic Complexity and Surgical Strategy
Creators: Satoka Shidoh - University of Iowa Health Care
Katherine J. Jensen - University of Iowa
Clayton L. Rosinski - University of Iowa
Kathleen E. Dlouhy - University of Iowa
Satoshi Yamaguchi - University of Iowa, Neurosurgery
Resource Type: Journal article
Publication Details: NMC case report journal, Vol.13, pp.457-462
DOI: 10.2176/jns-nmc.2026-0089
PMID: 42877945
PMCID: PMC13668433
NLM abbreviation: NMC Case Rep J
ISSN: 2188-4226
eISSN: 2188-4226
Publisher: Japan Neurological Society
Number of pages: 6
Language: English
Electronic publication date: 09/17/2026
Academic Unit: Neurosurgery
Record Identifier: 9985237617602771

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