The Etiology, Treatment, and Management of Bow Hunter's Syndrome: A Systematic Review and Comparison of Surgical and Conservative Treatments

Introduction: Bow Hunter's Syndrome (BHS) is a rare form of vertebrobasilar insufficiency caused by compression of the vertebral artery during rotational head movement, leading to reduced blood flow to the brain. Management options for BHS have been identified, but their frequencies are unknown. The most common surgical treatment is decompression, with or without hardware. Hardware is used in fusion, fixation, osteosynthesis, and arthrodesis. Conservative management included anti-platelet therapy, aspirin, a brace, or physical therapy.

Methods: A systematic literature search was conducted using PubMed and Cochrane for reports of Bow Hunter's Syndrome. Keywords "Bow Hunter Syndrome, Bow Hunter Stroke" were applied and references from these publications were also used. Variables of interest included sex distribution, symptoms, intervention methods, outcomes, and complications. Statistical analysis was performed to determine common symptoms. Conservative and surgical decompression treatments with or without hardware were analyzed. A chi-square test for independence was used to identify the treatment with better outcomes.

Results: 251 papers were screened, yielding 217 studies and 384 patients (68.97% male, mean age 48.99± 19.67 years) after inclusion and exclusion criteria. Patient presentation included vertigo (36.2%), syncope (35.9%), dizziness (27.9%), vision disturbances (17.2%), headache (13.0%), nausea (9.6%), and vomiting (6.0%). 113 (29.4%) patients underwent decompression surgery with hardware while 170 (44.3%) underwent decompression without hardware. 35 (9.1%) patients underwent conservative treatments. 174 out of 226 (76.99%) patients had complete resolution of symptoms following surgery, and 6 out of 19 (24.0%) patients with conservative treatment. The proportion of patients with complete resolution of symptoms was significantly greater in the surgery group (p < 0.001).

Conclusion : BHS is a disease that can affect people of all ages and can cause significant complications. Further studies are needed to determine the optimal management strategy for BHS patients and to better understand the underlying mechanisms of this rare but potentially serious condition.