Minimally Invasive Skull Base Approach Styloidectomy for Treatment of Eagle Syndrome

Eagle syndrome is an underrecognized condition caused by the elongation of the styloid process or calcification of the stylohyoid ligament, with an unknown true incidence. It is diagnosed clinically through symptoms related to compression of the surrounding neurovascular and musculoskeletal structures, along with radiographic confirmation of styloid elongation. Symptoms are variable and may include neck pain, dysphagia, tinnitus, dizziness, headaches, otalgia, and cognitive complaints. Surgical management via intraoral or transcervical approaches is the current standard of care. We propose a novel minimally invasive skull base approach designed to allow complete styloid removal with reduced tissue dissection.

A retrospective review was conducted in patients who underwent this minimally invasive skull base approach for Eagle syndrome between November 2020 and June 2024. Of 102 identified patients, 90 met the inclusion criteria. Demographics, operative time, intraoperative and postoperative complications, narcotic use, and symptom improvement were extracted from the electronic medical record. Data were analyzed using Excel.

Patients were predominantly female (73.3%) and white (90%). The mean operative time for unilateral styloid removal was 53 min (±21.2). The most common postoperative complication was temporary numbness (42.2%), with resolution reported in 63.2% of affected patients. Overall, 86.7% (n = 78) of patients reported complete or partial symptom improvement by or before the 3-month follow-up.

The minimally invasive skull base approach for Eagle syndrome demonstrates symptom improvement rates comparable to traditional intraoral and transcervical techniques while offering shorter operative times and limited tissue dissection. This approach appears to be an effective alternative surgical option with an acceptable complication profile.