Evaluation of abnormal styloid anatomy as a cause of internal jugular vein compression using a 3D-printed model: a laboratory investigation. (February 2020)

• Record Type: Journal Article
• Authors: Lehrman, Jennifer N.; Narayanan, Mohan; Cavallo, Claudio; Newcomb, Anna G.U.S.; Zhao, Xiaochun; Kelly, Brian P.; Crawford, Neil R.; Nakaji, Peter
• Is Part Of: Journal of clinical neuroscience. Volume 72(2020)
• Page Start: 386
• Page End: 391
• Publication Date: 2020-02
• Subjects: CSF cerebrospinal fluid -- CT computed tomogram -- ICP intracranial pressure -- IJV internal jugular vein -- PSI pounds per square inch -- SJVC styloidogenic jugular venous compression -- 3D 3-dimensional; 3D model -- Eagle syndrome -- Idiopathic intracranial hypertension -- Intracranial pressure -- Internal jugular vein -- Pseudotumor cerebri -- Styloid -- Styloidogenic jugular venous compression; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2019.11.048
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Styloidogenic jugular compression is one cause of pseudotumor cerebri. A patient-specific model was generated from an affected patient. Sequential styloid resection relieved compression, optimally with ≥75% removal. Abstract: This study used a 3-dimensional (3D) craniocervical junction model of styloidogenic jugular venous compression (SJVC) syndrome to simulate and evaluate intracranial pressure (ICP) after internal jugular vein (IJV) compression by an elongated styloid process during axial rotation. The 3D-printed model created using data from an SJVC-syndrome patient included an articulating occipital-cervical junction, simplified arteriovenous system, gauge to measure simulated ICP, fixed obstruction simulating left-sided venous occlusion, and right-sided vascular tubing to simulate IJV compression. The model was rotated axially to its extreme right and left; maximum degree of motion and pressure were recorded for 3 cycles. Measurements were repeated after styloid resection in 25% increments. The extreme right rotation (11°) of the intact styloid condition yielded a mean pressure of 15.34 ± 2.85 mmHg. After 25% styloid resection, extreme rotation (11°) yielded 13.96 ± 2.88 mmHg. After 50%, extreme rotation increased to 16° yielding 17.41 ± 3.52 mmHg; 11° rotation was 2.76 ± 1.96 mmHg. After 75%, extreme rotation increased to 19° yielding −0.86 ± 1.08 mmHg; 16° and 11° rotation yielded −0.69 ± 1.19 and −0.86 ± 1.08 mmHg, respectively. After 100%, extreme rotation to 19° yielded −1.21 ± 0.60 mmHg; 16° and 11° rotation yielded −0.34 ± 0.30 and 0.00 ± 0.00 mmHg, respectively. Extreme left rotations (11°) yielded mean pressures of −0.17 ± 0.00 (intact), −0.17 ± 0.30 (25%), 2.24 ± 0.79 (50%), 0.34 ± 0.30 (75%), and 0.17 ± 0.30 mmHg (100%). Simulated ICP increased proportionally to maximum ipsilateral axial rotation, and was highest after 50% styloid resection. Contralateral axial rotation did not increase pressure. IJV compression was relieved at 75% resection, suggesting that partial (75%) or complete styloidectomy is a potentially efficacious treatment for SJVC syndrome.