An Evaluation of Styloidectomy as an Adjunct or Alternative to Jugular Stenting in Idiopathic Intracranial Hypertension and Disturbances of Cranial Venous Outflow

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Abstract

Background

The 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.

Objective

To describe our technique and experience of styloidectomy combined with jugular stenting in the treatment of skull base narrowing of the jugular veins.

Methods

Retrospective 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.

Results

Eleven 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.

Conclusion

Styloidectomy can replace, salvage, or complement jugular venous stenting in IIH and disturbances of cranial venous outflow.

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