Venous outflow and quality of life improvement after styloidectomy and jugular venous decompression

The objective of this study was to evaluate hemodynamic and quality of life (QOL) outcomes after unilateral styloidectomy and jugular venous decompression (SJVD) in patients with treatment-resistant idiopathic intracranial hypertension (IIH) and Eagle syndrome (ES) associated with craniocervical venous insufficiency (CCVI).

The authors retrospectively reviewed the records of patients who, in the period from March 2019 to March 2024, underwent unilateral SJVD performed by a single ear, nose, and throat surgeon specializing in skull base surgery. Inclusion criteria were pre- and postoperative bilateral internal jugular vein (IJV) ultrasound and retrospective completion of standardized QOL assessments (Cerebral Venous Disorders Severity Scale [CVDSS], 6-Item Headache Impact Test [HIT-6], SF-12, and Quick Dementia Rating System [QDRS]), as well as preoperative CT venography (CTV). Surgical candidacy required an IJV flow gradient ≥ 50 cm/sec or severe symptoms with an elevated gradient, confirmed by imaging. The surgical technique involved exposure and decompression of the IJV from the jugular foramen to the clavicle, followed by resection of impinging structures, sometimes including the C1 transverse process. Maximum flow gradients and QOL were compared pre- and post-SJVD using nonparametric tests. Additionally, 2 cases representative of the typical experience of CCVI and SJVD are presented.

Fifty-five patients were included in the study (median age 45 years, 72.73% female, median IIH symptom duration 7 years). All had visible stenosis on CTV; 90.91% of the patients had a flow gradient ≥ 50 cm/sec. The most common stenosis site was at C1 (100%), with the most frequent maximum flow gradient observed between the carotid bulb and sternocleidomastoid muscle (SCM; 43.64%). The maximum overall gradient did not change significantly for the cohort; however, significant reductions occurred at the preoperative point of maximum gradient (median change -36.9 cm/sec, p < 0.001), on the side ipsilateral to surgery overall (p < 0.001), and at ipsilateral and contralateral maximum-gradient points (p < 0.001 for both). No significant changes occurred at the jugular foramina. Scores on all QOL measures improved significantly: CVDSS, HIT-6, SF-12 Mental Component Summary and Physical Component Summary, and QDRS behavioral, cognitive, and total (p < 0.001 for all measures).

SJVD yielded significant localized hemodynamic improvement and QOL gains in patients with treatment-resistant IIH and ES. Benefits were most pronounced at focal obstruction sites, particularly at C1 and the carotid bulb/SCM corridor, with evidence of contralateral hemodynamic improvement via collateral pathways. These findings support SJVD for select patients with CCVI, highlighting the importance of targeted imaging, rigorous selection criteria, and multidisciplinary management.