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-BACKGROUND: Bow hunter syndrome describes a mechanical compression of the vertebral artery on head rotation leading to reversible symptomatic vertebrobasilar insufficiency. Patients are commonly presenting with syncope, vertigo, dizziness, and visual disturbances. These symptoms usually resolve when the head is turned back into neutral position. Treatment options involve surgical decompression with or without fusion, bypass surgery, or endovascular intervention.

-CASE DESCRIPTION: We report about a 49-year-old female who presented with vague neck pain and severe vertigo, nausea, and near syncope when her head turned up and right. Computed tomography angiography revealed a pseudoaneurysm at the dominant left V3 and near total occlusion of the left vertebral artery as it exited the C2 foramen when the head was turned to the previously mentioned position. The patient could be successfully treated by computed tomographyLnavigated posterior instrumentation using bilateral C1 lateral mass screws and C2 translaminar screws. To promote segmental fusion, bilateral intrafacet cages were implanted. Postoperatively, the patient remained without neurologic deficits and experienced no further episodes of the preoperatively reported transient vertebrobasilar insufficiency symptoms.