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Neurosurgery. 2011 Aug 19. [Epub ahead of print]

Styloidogenic Jugular Venous Compression Syndrome: Diagnosis and Treatment.

Dashti SR, Nakaji P, Hu YC, Frei DF, Abla AA, Yao T, Fiorella D.

Source

1Norton Neuroscience Center, Norton Healthcare, Louisville, KY; 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; 3Division of Neurosurgery and Neuroradiology, Cerebrovascular Center, State University of New York at Stony Brook, Stony Brook, NY; 4Swedish Medical Center, Englewood, CO.

Abstract

BACKGROUND AND IMPORTANCE:

Intracranial venous hypertension is known to be associated with venous outflow obstruction. We discuss the diagnosis and treatment of mechanical venous outflow obstruction causing pseudotumor cerebri.

CLINICAL PRESENTATION:

We report two patients presenting with central venous outflow obstruction secondary to osseous compression of the internal jugular veins at the craniocervical junction. The point of jugular compression was between the lateral tubercle of C1 and a prominent, posteriorly located styloid process. In both cases catheter venography showed high-grade jugular stenosis at the level of C1 with an associated pressure gradient. The dominant jugular vein was decompressed after the styloid process was resected. Postoperative imaging confirmed resolution of the jugular stenosis and normalization of preoperative pressure gradients. In both cases the symptoms of intracranial hypertension resolved.

CONCLUSION:

Intracranial venous hypertension may result from extrinsic osseous compression of the jugular veins at the skull base. Although rare, this phenomenon is important to recognize because primary stenting is not only ineffective, it may actually exacerbate the outflow obstruction. The osseous impingement of the dominant jugular vein can be relieved via a decompressive styloidectomy, and the clinical results can be excellent.

by the way idiopathic cranial hypertension is very well treated by a gastric bypass....

This does not have anything to do with jugular vein compression, does it? The spinal vertebrae may affect the cerebrospinal flow or the spinal cord, and maybe the smaller veins of the spine, but not the jugulars, which are further away.

Med Biol Eng Comput. 2002 Jul;40(4):423-31.

Circulatory effects of internal jugular vein compression: a computer simulation study.

Bosnjak R, Kordas M.

Department of Neurosurgery, University Hospital Center, Ljubljana, Slovenia.

Abstract

The effects of compression of the internal jugular veins and the inferior vena cava are simulated using an equivalent electronic circuit, which included simulation of cardiocirculatory phenomena and special features of the cerebral circulation. Compression of the inferior vena cava resulted in a profound decrease in cardiac output (from 4.5 to 1.51min(-1)) and arterial pressure (from 140/85 to 50/35 mmHg). Compression of the internal jugular veins resulted in a negligible decrease in cardiac output and arterial pressure, with a cerebral blood flow that was slightly decreased. Cerebral capillary and internal jugular pressures were considerably increased, leading to obstruction of cerebral veins and increased pressure (from 9 to 22 mmHg) and volume (from 120 to 145 ml) of the cerebrospinal fluid (CSF). Increased cerebral capsule compliance resulted in decreased CSF pressure (from 9 to 8.5 mmHg), but CSF volume increased (from 120 to 190 ml). A small increase in brain volume (from 1,000 ml to 1,060 ml, 6% volume increase) was compensated for by an equal decrease in the volume of CSF. When brain volume was above 1,080 ml, the absorption of CSF was reduced, and its pressure increased.

Jugular Vein Obstruction Caused by Turning of the Head

Neurosurgery. 2011 Aug 19. [Epub ahead of print]

Styloidogenic Jugular Venous Compression Syndrome: Diagnosis and Treatment.

Dashti SR, Nakaji P, Hu YC, Frei DF, Abla AA, Yao T, Fiorella D.

Source

1Norton Neuroscience Center, Norton Healthcare, Louisville, KY; 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; 3Division of Neurosurgery and Neuroradiology, Cerebrovascular Center, State University of New York at Stony Brook, Stony Brook, NY; 4Swedish Medical Center, Englewood, CO.

Abstract

BACKGROUND AND IMPORTANCE:

Intracranial venous hypertension is known to be associated with venous outflow obstruction. We discuss the diagnosis and treatment of mechanical venous outflow obstruction causing pseudotumor cerebri.

CLINICAL PRESENTATION:

We report two patients presenting with central venous outflow obstruction secondary to osseous compression of the internal jugular veins at the craniocervical junction. The point of jugular compression was between the lateral tubercle of C1 and a prominent, posteriorly located styloid process. In both cases catheter venography showed high-grade jugular stenosis at the level of C1 with an associated pressure gradient. The dominant jugular vein was decompressed after the styloid process was resected. Postoperative imaging confirmed resolution of the jugular stenosis and normalization of preoperative pressure gradients. In both cases the symptoms of intracranial hypertension resolved.

CONCLUSION:

Intracranial venous hypertension may result from extrinsic osseous compression of the jugular veins at the skull base. Although rare, this phenomenon is important to recognize because primary stenting is not only ineffective, it may actually exacerbate the outflow obstruction. The osseous impingement of the dominant jugular vein can be relieved via a decompressive styloidectomy, and the clinical results can be excellent.

A small increase in brain volume (from 1,000 ml to 1,060 ml, 6% volume increase) was compensated for by an equal decrease in the volume of CSF. When brain volume was above 1,080 ml, the absorption of CSF was reduced, and its pressure increased.

http://www.ncbi.nlm.nih.gov/pubmed/21866063

I should probably know what a 'styloid process' is. But it sounds like it can be removed altogether. Does anyone here at TiMS have osseous impingmenet of the jugular vein, and is a decompressive styloidectomy an option that has ever been suggested? I wonder! I also love articles in which the words jugulars and outflow obstructions are used in the same sentences.

Frequently, the transverse process of the C1 vertebra will visibly indent the jugular vein (since the vein lies on this bony structure) however, a balloon will inflate under minimal pressure and Valsalva maneuver will enlarge the compressed vein during angiography or IVUS confirming this normal relationship.