Abstract
Object:
Styloidogenic venous compression is a rare cause of idiopathic intracranial hypertension. This diagnosis is often reached after extensive diagnostic work up reveals no source for the patients’ symptomatology of headache. The object of this current study is to review the characteristics of patients with styloidogenic venous compression, define diagnostic criteria for patients that would benefit from intervention and to describe the technique and outcomes of our transcervical microsurgical approach for treatment of this pathology.
Methods:
A retrospective single institution series of five consecutive patients (3 male, 2 female; mean age 37 years, range 21-61 years) with diagnosis of styloidogenic venous outflow obstruction is presented.
Results:
All patients presented with headaches in which four of the cases could be exacerbated with neck flexion. The majority of the patients were male and none of the patients were obese. In all cases, imaging revealed bilateral osseous compression of the venous outflow tracks. Dynamic venography and venous pressure measurements revealed focal stenosis at the site of osseous compression in all cases and a pressure gradient in 3 of 4 cases where pressure measurements were performed. All patients were treated via a trans-cervical styloid resection. At a mean follow up of 10.4 months, 3 patients experienced long term relief of their symptoms, while one patient experienced transient relief with relapse of symptoms at 8 months after surgery. In one patient, our surgical approach resulted in no benefit. In the patient that gained no benefit from surgical intervention, dynamic venography with neck flexion could not reproduce the symptoms.
Conclusion:
Styloidogenic venous compression is amendable to microsurgical treatment with most patients experiencing relief of symptomatology. Dynamic venography is a reliable diagnostic tool for differentiation of patients who would benefit from decompression.