Bilateral circumferential ınternal jugular vein decompression for atlanto-styloid compression syndrome: Report of 14 cases

BACKGROUND AND OBJECTIVES: External compression of the internal jugular vein (IJV) between the transverse process of the atlas (C1TP) and the styloid process is an emerging nosological entity. Various surgical treatment methods have been used, yet there is no consensus regarding the optimal surgical strategy. In this article, we present a novel surgical technique and clinical outcomes of 14 patients treated with circumferential decompression. METHODS: A retrospective chart review of 14 patients (9 men, 5 women) diagnosed with IJV stenosis between the C1TP and the styloid process was performed. The surgical technique included styloidectomy, C1 transversectomy, myectomy of the styloid muscles and posterior belly of the digastric muscle, transection of the occipital artery, and wide opening of the carotid sheath around the IJV. All but 1 patient underwent bilateral decompression. Clinical evaluation included self-reported improvement on a subjective improvement scale. Radiological assessment was performed by comparison of pre-and postoperative IJV cross-sectional area (CSA) at the point of maximal stenosis. A paired t-test was used for statistical analysis. RESULTS: The mean age was 44.7 yr (25-60), and the mean follow-up duration was 488 days (range 329-761). The right mean IJV CSA increased from 18.3 to 46.1 mm 2 (P = .0058). The left mean IJV CSA increased from 10.1 to 28.8 mm 2 (P = .000076). The IJVs shifted and expanded posteriorly toward the C1TP resection cavities in all cases. Nine patients reported significant and 5 moderate improvements. One patient developed transient trapezius muscle weakness because of XI nerve palsy. CONCLUSION: Bilateral circumferential IJV decompression is a feasible and safe technique and provides maximal IJV decompression.