An Evaluation of Styloidectomy as an Adjunct or Alternative to Jugular Stenting in Idiopathic Intracranial Hypertension and Disturbances of Cranial Venous Outflow.
BackgroundThe extent to which intracranial venous sinus obstruction contributes to idiopathic intracranial hypertension (IIH) is debated. The extent to which extracranial venous obstruction contributes to IIH is virtually unexplored. This article describes an interventional approach to extracranial venous outflow in a group of patients with severe intractable symptoms.ObjectiveTo describe our technique and experience of styloidectomy combined with jugular stenting in the treatment of skull base narrowing of the jugular veins.MethodsRetrospective review of all styloidectomies undertaken at our institution (n= 34), as an adjunct or alternative to jugular venous stenting, with a view to improving cranial venous outflow.ResultsEleven styloidectomies were for delayed complications of jugular stenting. Of seven with stent dysfunction, three were improved and four unchanged. Of seven with accessory nerve compression (three had both), four resolved and three improved. In 23 instances, styloidectomy preceded or obviated jugular stenting. Two had a virtual resolution of symptoms, 13 were improved, and 8 were unchanged.ConclusionStyloidectomy can replace, salvage, or complement jugular venous stenting in IIH and disturbances of cranial venous outflow.
Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom.
J Nicholas
JN
Higgins
Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
Mathew R
MR
Garnett
Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
John D
JD
Pickard
Cambridge Skull Base Unit, Addenbrooke's Hospital, Cambridge, United Kingdom.
Patrick R
PR
Axon
cranial venous outflow; idiopathic intracranial hypertension; jugular stenting; styloidectomy