Abstract 109: A Decade Of Headaches Unraveled: Jugular Decompression Via C1 Osteotomy In Venous Eagle Syndrome
Year: 2025
Type: conference-abstract
Abstract: Background Eagle syndrome is a rare disorder most commonly associated with an elongated styloid process, which can lead to cervicofacial pain, dysphagia, or compression of the carotid artery. A lesser‐known variant, venous Eagle syndrome, involves compression of the internal jugular vein (IJV), typically between the styloid process and the C1 transverse process. This anatomic narrowing can impair venous outflow from the brain, potentially producing a wide range of neurologic symptoms. While increasingly recognized in the pathophysiology of headache disorders, the optimal surgical approach remains debated. In particular, the role of C1 transverse process osteotomy as a stand‐alone, definitive treatment is poorly documented and significantly underreported in the literature. Case Presentation A 57‐year‐old woman with no significant past medical history presented with intractable right‐sided headaches and facial pain that had persisted for over a decade. These headaches were near‐daily, disabling, and unresponsive to both abortive and preventive medical therapy. She denied associated nausea, vomiting, photophobia, phonophobia, or visual disturbances. The chronic pain substantially impacted her quality of life, limiting both daily activities and work productivity. An extensive diagnostic evaluation was performed. CT brain, CTA neck, and CTA brain revealed no acute intracranial pathology or vascular malformations. Multiple neurologists had previously trialed various medications and conservative measures without improvement. Given her refractory course, diagnostic cerebral venography with manometry was undertaken. This revealed bilateral IJV stenosis due to compression between the styloid process and the C1 transverse process, with more severe narrowing on the left. Dynamic imaging demonstrated complete occlusion of the left IJV in certain neck positions. Critically, manometry confirmed a >4 cm H₂O pressure gradient across the stenosis, establishing its hemodynamic significance. She subsequently underwent microsurgical resection of the left C1 transverse process using stereotactic navigation. Notably, no styloidectomy was performed. The procedure was uneventful, and in the immediate postoperative period she experienced complete resolution of her headaches and facial pain. At three‐month follow‐up, she remained entirely symptom‐free without the need for medication; representing her first sustained remission in more than ten years. Discussion This case highlights the importance of considering venous Eagle syndrome in the differential diagnosis of chronic, unexplained headaches; particularly when standard neurovascular imaging is unrevealing. While traditional management has centered on styloidectomy, our findings demonstrate that targeted C1 transverse process osteotomy alone can be curative when the bony impingement at C1 is the primary driver of IJV compression. Manometry played a decisive role in confirming the physiologic impact of the stenosis, thereby justifying surgical intervention. For select patients with refractory headaches and objectively documented venous outflow obstruction, C1 transverse process resection may provide complete and durable symptom relief. This case adds to the limited body of literature describing this targeted surgical approach and underscores the need for greater clinical awareness of venous Eagle syndrome in comprehensive headache evaluation.
Authors: J. Fernandez, C. Eshraghi, A. Hijazin, W. Vera, M. Barrera, J. Tran, B. Tang, K. Guillen, C. E. Stout, N. Sahasrabudhe
Institution: Riverside Community Hospital
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,300
OpenAlex ID: W4416921505
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