Internal Jugular Vein Compression Syndrome, Extreme Lateral Infracondylar (ELI) Approach and Preliminary Clinical Outcome

Objective: Internal jugular vein (IJV) stenosis has been associated with idiopathic intracranial hypertension and pulsatile tinnitus. IJV stenting has been occasionally used in the treatment of these conditions. However, in cases of extreme IJV stenosis and bony compression, endovascular treatment is not safe or technically feasible. The infracondylar region is a critical area surrounded by important neurovascular structures and the surgical exposure is challenging.

Methods: We retrospectively reviewed our surgical experience of surgical IJV decompression via the extreme lateral approach from July 2020 to September 2021.

Results: Seven patients met criteria for IJV decompression with severe headache and intracranial hypertension signs in three and intractable unilateral pulsatile tinnitus in four. All patients underwent extensive work up, including high resolution computed tomography (CT) with venogram, magnetic resonance imaging (MRI), digital subtraction angiography and venogram. A pressure gradient across the stenosed segment of IJ was detected on venogram in all patients. All had evidence of IJV compression from styloid process anteriorly and transverse process (TP) of C1 posteriorly. Surgical IJV decompression was performed via an extreme lateral infracondylar (ELI) approach, styloidectomy, release of soft tissue, and removal of C1 TP. Four patients had improvement of their initial presenting symptoms. Post-operative CTV showed complete decompression of IJV with re-expansion in 5 patients, persistent narrowing due to soft tissue surrounding the IJV in one patient, and an intrinsic IJV narrowing in one despite satisfactory bony decompression. One patient had a spinal accessory nerve palsy postoperatively, one patient complained of lower facial numbness and one developed an infection necessitating a wound revision. No other neurological morbidities or mortality were encountered.

Conclusion: ELI approach for IJV decompression is a new neurosurgical approach for IJ compressive syndrome and appears to be safe. Whether the long-term results confirm its efficacy in relieving debilitating clinical symptoms necessitates longer term follow-up and larger number of patients. Carefully selected patients with symptomatic IJ compressive syndrome for whom there is no endovascular or other options, may benefit from surgical decompression.

Publication History

Article published online:
15 February 2022