Symptomatic vertebral artery (VA) compression resulting from head rotation is sometimes termed “Bow hunter’s syndrome” [1], [2], [3]. This condition, first identified by Sorensen in 1978, involves VA compression due to specific head movements [3]. This narrowing can result from various causes, including atherosclerosis lesion or mechanical compression of the artery by lesions such as tumors or osteophytes [4]. Originating from the subclavian artery, the VA enters the cervical spine through the transverse foramen of the sixth cervical vertebrae [5]. It then ascends along the spine, exist at C1 level, and after piercing the dura, enters the cranium through the foramen magnum ensuring blood flow to the encephalon’s posterior circulation [4], [5]. Hence, any obstruction of the VA might lead to symptoms associated with posterior circulation strokes symptoms like visual complains, gait disturbances or syncope [2], [6], [7], [8]. As a result, patients who presents with the aforementioned neurological complains following head rotation, should be investigated for BHS.

The objective of this paper is to conduct a systematic review of the literature pertaining to the surgical management of Bow hunter’s syndrome from osteophytes. We also describe the surgical management of two cases where an osteophyte compresses the vertebral artery causing recurrent episodes of syncope.

The methodology of this review adhered to the preferred reporting items for systematic reviews and meta-analysis statement (PRISMA) guidelines and checklist [9].