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Extreme lateral infracondylar approach for internal jugular vein compression syndrome: A case series with preliminary clinical outcomes

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Abstract

Background and objectives

Internal jugular vein (IJV) stenosis is associated with several neurological disorders including idiopathic intracranial hypertension (IIH) and pulsatile tinnitus. In cases of extreme bony compression causing stenosis in the infracondylar region, surgical decompression might be necessary. We aim to examine the safety and efficacy of surgical IJV decompression.

Methods

We retrospectively reviewed patients who received surgical IJV decompression via the extreme lateral infracondylar (ELI) approach between July 2020 and February 2022.

Results

Fourteen patients with IJV stenosis were identified, all with persistent headache and/or tinnitus. Six patients were diagnosed with IIH, three of whom failed previous treatment. Of the eight remaining patients, two failed previous treatment. All underwent surgical IJV decompression via styloidectomy, release of soft tissue, and removal of the C1 transverse process (TP). Follow-up imaging showed significant improvement of IJV stenosis in eleven patients and mild improvement in three. Eight patients had significant improvement in their presenting symptoms, and three had partial improvement. Two patients received IJV stenting after a lack of initial improvement. Two patients experienced cranial nerve paresis, and one developed a superficial wound infection.

Conclusion

The ELI approach for IJV decompression appears to be safe for patients who are not ideal endovascular candidates due to bony anatomy. Confirming long-term efficacy in relieving debilitating clinical symptoms requires longer follow-up and a larger patient cohort. Carefully selected patients with symptomatic bony IJV compression for whom there are no effective medical or endovascular options may benefit from surgical IJV decompression.

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Data Availability

Data is available by request to the corresponding author.

Abbreviations

CTV:

Computed tomography venogram

DSA:

Digital subtraction venography

ELI:

Extreme lateral infracondylar

IIH:

Idiopathic intracranial hypertension

IJV:

Internal jugular vein

MRI:

Magnetic resonance imaging

TP:

Transverse process

References

  1. Bai C, Wang Z, Guan J, Jin K, Ding Y, Ji X et al (2020) Clinical characteristics and neuroimaging findings in eagle syndrome induced internal jugular vein stenosis. Ann Trans Med 8(4):97. https://doi.org/10.21037/atm.2019.12.93

    Article  Google Scholar 

  2. Bateman GA (2008) Arterial inflow and venous outflow in idiopathic intracranial hypertension associated with venous outflow stenoses. J Clin Neurosci 15(4):402–408. https://doi.org/10.1016/j.jocn.2007.03.018

    Article  PubMed  Google Scholar 

  3. Ceylan A, Köybasioglu A, Celenk F, Yilmaz O, Uslu S (2008) Surgical treatment of elongated styloid process: experience of 61 cases. Skull Base 18(5):289–95. https://doi.org/10.1055/s-0028-1086057

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chung C-P, Beggs C, Wang P-N, Bergsland N, Shepherd S, Cheng C-Y et al (2014) Jugular venous reflux and white matter abnormalities in Alzheimer’s disease: a pilot study. J Alzheimer’s Dis 39(3):601–609. https://doi.org/10.3233/jad-131112

    Article  Google Scholar 

  5. Chung C-P, Hsu H-Y, Chao A-C, Sheng W-Y, Soong B-W, Hu H-H (2007) Transient global amnesia: cerebral venous outflow impairment-insight from the abnormal flow patterns of the internal jugular vein. Ultrasound Med Biol 33(11):1727–1735. https://doi.org/10.1016/j.ultrasmedbio.2007.05.018

    Article  PubMed  Google Scholar 

  6. Dashti SR, Nakaji P, Hu YC, Frei DF, Abla AA, Yao T et al (2012) Styloidogenic jugular venous compression syndrome: diagnosis and treatment: case report. Neurosurgery 70(3):E795–E799. https://doi.org/10.1227/NEU.0b013e3182333859

    Article  PubMed  Google Scholar 

  7. Ding J-Y, Zhou D, Pan L-Q, Ya J-Y, Liu C, Yan F et al (2020) Cervical spondylotic internal jugular venous compression syndrome. CNS Neurosci Ther 26(1):47–54. https://doi.org/10.1111/cns.13148

    Article  PubMed  Google Scholar 

  8. Fritch C, Voronovich Z, Carlson AP (2020) C1 transverse process resection for management of jugular stenosis. Oper Neurosurg (Hagerstown) 19(2):E209–E213. https://doi.org/10.1093/ons/opaa032

    Article  PubMed  Google Scholar 

  9. Higgins JN, Garnett MR, Pickard JD, Axon PR (2017) An evaluation of styloidectomy as an adjunct or alternative to jugular stenting in idiopathic intracranial hypertension and disturbances of cranial venous outflow. J Neurol Surg B Skull Base 78(2):158–163. https://doi.org/10.1055/s-0036-1594238

    Article  PubMed  Google Scholar 

  10. Hsu H-Y, Chao A-C, Chen Y-Y, Yang F-Y, Chung C-P, Sheng W-Y et al (2008) Reflux of jugular and retrobulbar venous flow in transient monocular blindness. Ann Neurol 63(2):247–538. https://doi.org/10.1002/ana.21299

    Article  CAS  PubMed  Google Scholar 

  11. Jayaraman MV, Boxerman JL, Davis LM, Haas RA, Rogg JM (2012) Incidence of extrinsic compression of the internal jugular vein in unselected patients undergoing CT angiography. AJNR Am J Neuroradiol 33(7):1247–50. https://doi.org/10.3174/ajnr.A2953

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Karahalios DG, Rekate HIL, Khayata MH, Apostolides PJ (1996) Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology 46(1):198–202. https://doi.org/10.1212/wnl.46.1.198

    Article  CAS  PubMed  Google Scholar 

  13. Kharkar S, Hernandez R, Batra S, Metellus P, Hillis A, Williams MA, Rigamonti D (2011) Cognitive impairment in patients with pseudotumor cerebri syndrome. Behav Neurol 24(2):143–8. https://doi.org/10.3233/BEN-2011-0325

    Article  PubMed  PubMed Central  Google Scholar 

  14. King JO, Mitchell PJ, Thomson KR, Tress BM (1995) Cerebral venography and manometry in idiopathic intracranial hypertension. Neurology 45(12):2224–2228. https://doi.org/10.1212/wnl.45.12.2224

    Article  CAS  PubMed  Google Scholar 

  15. Lenck S, Radovanovic I, Nicholson P, Hodaie M, Krings T, Mendes-Pereira V (2018) Idiopathic intracranial hypertension: the veno glymphatic connections. Neurology 91(11):515–522. https://doi.org/10.1212/WNL.0000000000006166

    Article  PubMed  Google Scholar 

  16. Li M, Gao X, Rajah GB, Liang J, Chen J, Yan F, Bao Y, Jiao L, Zhang H, Ding Y, Ji X, Meng R (2019) Styloidectomy and venous stenting for treatment of styloid-induced internal jugular vein stenosis: a case report and literature review. World Neurosurg 129–32. https://doi.org/10.1016/j.wneu.2019.06.100

  17. Li M, Sun Y, Chan CC, Fan C, Ji X, Meng R (2019) Internal jugular vein stenosis associated with elongated styloid process: five case reports and literature review. BMC Neurol 19(1):112. https://doi.org/10.1186/s12883-019-1344-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Li M, Sun Y, Chan CC, Fan C, Ji X, Meng R (2019) Internal jugular vein stenosis associated with elongated styloid process: five case reports and literature review. BMC Neurol 19(1):112. https://doi.org/10.1186/s12883-019-1344-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Mejia-Vergara AJ, Sultan W, Kostas A, Mulholland CB, Sadun A (2021) Styloidogenic jugular venous compression syndrome with papilloedema: case report and review of the literature. Neuroophthalmology 46(1):54–8. https://doi.org/10.1080/01658107.2021.1887288

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mooney J, Lepard J, Akbari SHA, Johnston JM (2020) Styloidogenic jugular venous compression syndrome: a case report and review of the literature. Childs Nerv Syst 36(12):3135–9. https://doi.org/10.1007/s00381-020-04622-6

    Article  PubMed  Google Scholar 

  21. Nedelmann M, Kaps M, Mueller-Forell W (2009) Venous obstruction and jugular valve insufficiency in idiopathic intracranial hypertension. J Neurol 256(6):964–969. https://doi.org/10.1007/s00415-009-5056-z

    Article  PubMed  Google Scholar 

  22. Primiani CT, Lawton M, Hillis AE, Hui FK (2022) Pearls & Oy-sters: Cerebral venous congestion associated with cognitive decline treated by jugular release. Neurology 99(13):577–580. https://doi.org/10.1212/WNL.0000000000201037

    Article  CAS  PubMed  Google Scholar 

  23. Sattur MG, Amans M, Fargen KM, Huisman TAGM, Brinjikji W, Hui F, Shingala A, Vosler PS, Pereira VM, Hepworth E, Dehdashti AR, Patsalides A, Lo SL, Spiotta AM (2023) Angiographic evaluation of cranial venous outflow patterns in patients with and without idiopathic intracranial hypertension. Oper Neurosurg (Hagerstown) 24(1):e29–e35. https://doi.org/10.1227/ons.0000000000000413

    Article  PubMed  Google Scholar 

  24. Scerrati A, Norri N, Mongardi L, Dones F, Ricciardi L, Trevisi G et al (2021) Styloidogenic- cervical spondylotic internal jugular venous compression, a vascular disease related to several clinical neurological manifestations: diagnosis and treatment-a comprehensive literature review. Ann Trans Med. 9(8):718. https://doi.org/10.21037/atm-20-7698

    Article  Google Scholar 

  25. Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 147(8):573–577

    Article  Google Scholar 

  26. Yri HM, Fagerlund B, Forchhammer HB, Jensen RH (2014) Cognitive function in idiopathic intracranial hypertension: a prospective case-control study. BMJ Open 4(4):e004376. https://doi.org/10.1136/bmjopen-2013-004376

    Article  PubMed  PubMed Central  Google Scholar 

  27. Zamboni P, Scerrati A, Menegatti E, Galeotti R, Lapparelli M, Traina L et al (2019) The eagle jugular syndrome. BMC Neurol 19(1):333. https://doi.org/10.1186/s12883-019-1572-3

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhao X, Cavallo C, Hlubek RJ, Mooney MA, Belykh E, Gandhi S, Moreira LB, Lei T, Albuquerque FC, Preul MC, Nakaji P (2019) Styloidogenic jugular venous compression syndrome: clinical features and case series. Oper Neurosurg (Hagerstown) 17(6):554–561. https://doi.org/10.1093/ons/opz012

    Article  PubMed  Google Scholar 

  29. Zhou D, Ding J, Asmaro K, Pan L, Ya J, Yang Q et al (2019) Clinical characteristics and neuroimaging findings in internal jugular venous outflow disturbance. Thromb Haemost 119(2):308–318. https://doi.org/10.1055/s-0038-1676815

    Article  PubMed  Google Scholar 

  30. Zhou D, Ding J-Y, Ya J-Y, Pan L-Q, Yan F, Yang Q et al (2018) Understanding jugular venous outflow disturbance. CNS Neurosci Ther 24(6):473–82. https://doi.org/10.1111/cns.12859

    Article  PubMed  PubMed Central  Google Scholar 

  31. Zhou D, Meng R, Zhang X, Guo L, Li S, Wu W et al (2018) Intracranial hypertension induced by internal jugular vein stenosis can be resolved by stenting. Eur J Neurol 25:365-e13. https://doi.org/10.1111/ene.13512

    Article  CAS  PubMed  Google Scholar 

  32. Zhou D, Meng R, Zhang X, Guo L, Li S, Wu W, Duan J, Song H, Ding Y, Ji X (2018) Intracranial hypertension induced by internal jugular vein stenosis can be resolved by stenting. Eur J Neurol 25(2):365-e13. https://doi.org/10.1111/ene.13512

    Article  CAS  PubMed  Google Scholar 

  33. Zivadinov R, Chung C-P (2013) Potential involvement of the extracranial venous system in central nervous system disorders and aging. BMC Med 11:260. https://doi.org/10.1186/1741-7015-11-260

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank Ms. Elyssa Siegel for her assistance with the illustrations in Figure 2.

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Authors and Affiliations

  1. Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA

    Kaiyun Yang, Kevin Shah, Sabrina L. Begley, Giyarpuram Prashant, Timothy White, Sheng-Fu Larry Lo & Amir R. Dehdashti

  2. Community Neurosciences Institute, Community Health Partners, Fresno, CA, USA

    Kaiyun Yang

  3. Department of Neurosurgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Giyarpuram Prashant

  4. Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA

    Peter Costantino

  5. Department of Interventional Neuroradiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA

    Athos Patsalides

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Correspondence to Amir R. Dehdashti.

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Yang, K., Shah, K., Begley, S.L. et al. Extreme lateral infracondylar approach for internal jugular vein compression syndrome: A case series with preliminary clinical outcomes. Acta Neurochir 165, 3445–3454 (2023). https://doi.org/10.1007/s00701-023-05779-0

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