OBJECTIVE AND IMPORTANCE: Bow hunter's stroke is a symptomatic vertebrobasilar 
insufficiency caused by stenosis or occlusion of the vertebral artery at the 
C1C2 level with head rotation. No case of anterior decompression of the 
vertebral artery for surgical treatment of bow hunter's stroke has been 
reported.
CLINICAL PRESENTATION: A 47-year-old male patient presented with repeated 
episodes of unconsciousness caused by turning his head approximately 40 degrees 
to the right; he recovered consciousness within approximately 10 seconds after 
his head was returned to the neutral position. Angiography revealed an occluded 
right vertebral artery and temporary occlusion of the left vertebral artery, at 
the level of the C2 transverse foramen, when the patient's head was turned 
approximately 40 degrees to the right.
INTERVENTION: Anterior decompression of the left vertebral artery at the 
transverse foramen of the axis was performed. Postoperative angiography 
demonstrated sufficient flow in the left vertebral artery even when the neck was 
rotated.
CONCLUSION: The patient was discharged without neurological deficits. We 
demonstrate that simple surgical untethering of the vertebral artery at the 
transverse foramen of the axis is an effective method of treatment that avoids 
the limitation of head rotation. The advantage of this procedure is that it does 
not result in postoperative restriction of the patient's neck movements. The 
anterior approach, with decompression of the transverse foramen of the axis, in 
the present case provided adequate exposure of the vertebral artery and resulted 
in a satisfactory outcome.