Técnica quirúrgica para abordaje mínimamente invasivo para descompresión microvascular en el síndrome de Bow Hunter apoyado con angiografía dinámica

Abstract

Syndrome bow Hunter is a rare entity characterized by vertebrobasilar insufficiency precipitated by distal occlusion vertebral1 (V2 segment) at C1-C2 to the rotation of the head, which may be accompanied by specific neurological symptoms . From this first report there have been many discussions regarding the handling, always controversial because of its low incidence and reporte. Here we describe a technique for minimally invasive approach made through retractors shell and tubular retractors (spotlight) technique that allows minimal muscle dissection. After an advanced search only one article that met the search criteria focused on managing minimally surgical technique for decompression in Bow Hunter syndrome was documented, so we emphasize the academic relevance of this article to be the first study where experience comes in the management of Bow Hunter syndrome minimally invasive technique supported by intraoperative angiography. A total of 3 patients were documented with bow hunter syndrome, all men, ranging in age between 26 -44 years of age, in all three cases the main symptom was vertigo documenting infarction in the posterior territory in all cases. The diagnosis was made through digital subtraction angiography dynamic digital right and left extreme flexion. The surgical management was the therapeutic option in all cases, of these one was done by Far Side classical approach described in literatura. Cases handled with vascular decompression through minimally invasive approach had shorter recovery. Although the syndrome bow hunter is a rare, in our experience we believe that the minimally invasive approach in good surgical strategy that allows decompression of the vertebral artery with minimal bleeding and dissection, set treatment with angiographic support Intraoperative provides security in case of vascular injury as allows to immediately identify the resolution of the compression.