KRICHBAUM et al. (2022) - The jugular variant of Eagle Syndrome (translated from german)

General Research Papers
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Here is another fresh article from Germany. Seems as they are slowly recognizing here the problems IJVS can cause:

Introduction The syndrome caused by an elongated styloid process is divided into the classic variant with ipsilateral pain and dysphagia and the carotid variant with additional cerebral ischemia. In addition, the jugular Eagle syndrome has been described, which is caused by compression of the internal jugular vein (VJI) between the styloid process and the transverse process of cervical 1 and can present with variable symptoms such as headaches and perimesencephalic bleeding. In addition to physiotherapy and drug analgesia, surgical therapy is the method of choice. In rare cases, an interventional stent implantation can be performed.

History A 37-year-old man presented with isolated left-sided pulse-synchronous tinnitus for 9 months. A CT-A showed an elongated bilateral styloid process with left-sided, high-grade stenosis of the VJI in the subcranial segment. Invasive angiography demonstrated a pressure gradient along the VJI and nuchal and pterygoid venous collaterals. A left-sided styloidectomy was performed because of the high level of suffering. Postoperative CT-A continued to show a small caliber VJI. With subjectively only slight improvement in symptoms, an interventional angiographic follow-up followed 9 months postoperatively with the patient awake. The narrowing of the VJI was flexible and completely regressed under balloon insufflation, but remained unchanged after deflation.

Discussion The jugular Eagle syndrome requires a detailed anamnesis and diagnostics. There may be no relief of symptoms after surgical therapy, especially in the case of scarring changes in the vein wall. A stent implantation as an individual healing attempt can be evaluated using interventional angiography.

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:point_right: I want to mention, that for example Dr. Hepworth dissects strangulating scar tissue regularly from IJV and he usually manages without stenting.

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Thanks for sharing this- good it’s being more recognised in Germany!

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Thank you for the synopsis of the article @TheDude. The addition of how Dr. Hepworth deals with scar tissue is helpful, too.

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@TheDude Thank you so much for this! My brother found an article as well, I will share it when I find it again. I love that “in rare cases” the stenting can be done. Love being a rare case!!

I wish he could deal with MY scar tissue without a stent. I wonder what the differentiating factor is. I know mine is inside the vein, not external. I had external too, but he cut that away in the first surgery.

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@Bopper - My mom had angioplasty for a clogged heart artery (don’t recall which one) in 2005 & later developed scar tissue which was “burned” out of the vessel using an electric needle or something like that. The procedures were very similar in that her surgeon when in through her groin. Now I realize your problem is closer to your brain, but I’m wondering why something similar couldn’t be done in your situation? Maybe it’s the location?

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Interesting! I am so new to all of this, I have no idea. Maybe they can’t get the electric needle all the way from the groin to the brain. Or maybe they don’t want to risk needling the brain. I don’t know, but it would be nice!!

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I would expect if that was an alternative therapy, someone would have suggested it. It might be worth asking why something like that isn’t an option as you interview doctors while deciding what course of action is best for you.