scholarly journals An unusual internal carotid artery compression as a possible cause of Eagle syndrome – A novel hypothesis and an innovative surgical technique

2019 ◽  
Vol 10 ◽  
pp. 174 ◽  
Author(s):  
Karol Galletta ◽  
Francesca Granata ◽  
Marcello Longo ◽  
Concetta Alafaci ◽  
Francesco S. De Ponte ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Transverse Process ◽  
Styloid Process ◽  
Lower Lip ◽  
Patient Reported ◽  
Eagle Syndrome ◽  
The Right

Background: Eagle syndrome (ES) is a rare symptomatic condition generally caused by an elongated styloid process (SP) or calcification of the stylohyoid complex. On the diagnosis is made, its treatment remains subjective since the indications for surgical intervention are still not standardized. Although styloidectomy is the surgical treatment of choice, no consensus exists regarding the transcervical or/and transoral route. Here, we report our experience in a patient with bilateral internal carotid artery (ICA) dissection caused by ES, who underwent innovative surgical technique. Case Description: A 53-year-old man, with the right-sided middle cerebral artery acute stroke, underwent computed tomography angiography 3 days after a successful endovascular treatment. The study showed a bilateral ICA dissection with bilateral hypertrophic SPs and a close relationship of ICAs with both SPs anteriorly and C1 transverse process posteriorly. Considering the occurrence of ICA compression by a styloid/C1 transverse process juxtaposition, the patient underwent the left partial C1 transversectomy by an extraoral approach. A temporary paresis of the ipsilateral lower lip lasted 1 month, with a partial remission after 3 months. The patient reported significant improvement of symptoms with a good esthetics and functional outcome. Conclusion: A styloid/C1 transverse process juxtaposition should be considered as an alternative pathogenetic mechanism in vascular ES. When a posterior ICA compression by C1 transverse process is present, a bone reshaping of C1 rather than a conventional styloidectomy can be considered an efficacious treatment which allows a good preservation of the styloid muscles and ligaments.

scholarly journals Eagle syndrome as a rare cause of recurrent transient ischemic stroke in Senegal (West Africa)

2021 ◽  
Vol 7 (9) ◽  
pp. 1534
Author(s):  
Birame Loum ◽  
Cheikh Ahmedou Lame ◽  
Cheikhna B. Ndiaye ◽  
Kamadore Toure ◽  
Mouhamadou Mansour Ndiaye
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Rare Condition ◽  
Styloid Process ◽  
Neurological Impairment ◽  
Vascular Events ◽  
Eagle Syndrome

<p>Eagle syndrome is a rare condition, often characterized by nonspecific symptoms. It is due to an abnormally long or compressive styloid process on surrounding structures. Exceptionally, it can cause neuro-vascular manifestations. We report an observation of Eagle syndrome discovered incidentally in presence of recurrent transient ischemic stroke. A 74-year-old man with no cardiovascular risk factors, was admitted to our department following 4 episodes of transient ischemic stroke with right hemiplegia and aphasia, always rapidly resolving. Head and neck CT scan showed 2 long styloid processes with a marked impingement of the left one against the ipsilateral internal carotid artery. Intraoral styloidectomy was performed. The patient recovered fully and remained free of symptoms without neurological impairment, at 6 months. Eagle syndrome is a rare condition which may lead, exceptionally, to repetitive transient ischemic stroke. Surgical styloidectomy must be considered to reduce the risk of new vascular events and prevent serious complications such as dissection of the internal carotid artery.</p>

Transoral Endoscopic Localization of the Parapharyngeal Internal Carotid Artery

2021 ◽  
Author(s):  
Guoliang Zhang ◽  
Xia Zhao ◽  
Guangbin Sun ◽  
Nan Gao ◽  
Pengcheng Yu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Styloid Process ◽  
Transoral Approach ◽  
Direct Access ◽  
Carotid Canal ◽  
Bony Landmarks ◽  
The Right ◽  
Maxillary Tuberosity

Abstract Objectives To define transoral endoscopic surgical landmarks for the parapharyngeal segment of the internal carotid artery (ppICA) using cadaveric dissection. Materials and Methods Ten fresh cadaveric heads were dissected to demonstrate the parapharyngeal space anatomy and course of the ppICA as seen in a transoral approach. Anatomical measurements of the distance between the ppICA and bony landmarks were recorded and analyzed. Results The stylohyoid ligament, styloglossus, and stylopharyngeus could be considered to be the safe anterior boundary of the ppICA in the transoral approach; among them, the styloid ligament was the most rigid tissue. Dissection between the stylopharyngeus muscle and superior pharyngeal constrictor muscle provides direct access to the ppICA. At the level of the skull base, the distance from the root of the styloid process to the lateral margin of the external aperture of the carotid canal on the left side and on the right side was 8.57 ± 1.97 and 8.80 ± 1.21 mm, respectively. At the level of the maxillary tuberosity, the distance from the ppICA to the maxillary tuberosity on the left side and on the right side was 31.48 ± 2.24 and 31.01 ± 2.88 mm, respectively. Conclusion The endoscopic-assisted transoral approach can facilitate exposure of the ppICA. The root of the styloid process, styloid ligament, and maxillary tuberosity are critical landmarks in the identification of the ppICA in the transoral approach.

scholarly journals Relato de caso: Dissecção Carotídea associada a Síndrome de Eagle

2021 ◽  
Author(s):  
Vinícius de Queiroz Aguiar ◽  
Gustavo Sales França ◽  
Bernardo Costa Berriel Abreu ◽  
Talles Henrique Caixeta ◽  
Alexandre Henrique de Azevedo Dias ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Clinical Manifestations ◽  
Styloid Process ◽  
Left Internal Carotid Artery ◽  
Partial Recovery ◽  
Body Sensation ◽  
Eagle Syndrome ◽  
Vessel Dissection

Context: Eagle syndrome is characterized by the elongation or disfiguration of the styloid process, which leads to a range of clinical manifestations resulting from the structures that are affected by the prolongation of the bone, and the classic presentation is composed of pain and foreign body sensation in the throat, otalgia, and dysphagia. Case report: We describe the case of a 60-year-old man with an ischemic stroke due to dissection of the left internal carotid artery, associated with compression resulting from Eagle syndrome. At clinical presentation, the patient presented right hemiparesis and severe dysphagia, with NIH=18, characterizing the stroke. An angiotomography of the skull and brain was performed, which showed an image compatible with dissection of the left internal carotid artery from the prolongation of the styloid process, characterizing Eagle syndrome stylocarotid syndrome. The patient was submitted to thrombolysis with rt-PA, presenting a partial response, and surgical bone reduction. Patient evolved with partial recovery, with NIH=10, and, at the time of discharge, presented RANKIN 1, symptoms without disabilities. Conclusion: The Eagle syndrome, while it occurs more frequently in women, in general, with the classic presentation, can evolve with a more severe picture, associated with vessel dissection and brain involvement.

scholarly journals Stylocarotid syndrome: A case report

2008 ◽  
Vol 136 (11-12) ◽  
pp. 650-653 ◽  
Author(s):  
Branko Petrovic ◽  
Djordje Radak ◽  
Vladimir Kostic ◽  
Nadezda Covickovic-Sternic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Longitudinal Axis ◽  
Original Description ◽  
Styloid Process ◽  
Head Movements ◽  
Head Turning ◽  
History Of ◽  
The Right

INTRODUCTION The American otolaryngologist Eagle was the first to describe styloid syndrome in 1937 and the syndrome was named after him (Eagle's syndrome). The original description of two separate syndromes is connected with his name: classical syndrome, which almost constantly occurs after tonsillectomy and carotid artery syndrome, which occurs without tonsillectomy and also in cases when stylohyoid complex compresses the carotid segments and perivascular sympathetic fibers. In the following years, two more syndromes were defined: stylohyoid and pseudostylohyoid, which according to their manifestations, correspond to the genuine classical form. CASE OUTLINE A 40-year old male is presented, with a history of 3-year duration of pains in the upper part of the left side of the neck, in the left eye and its surroundings. Pain occurrences were not regular. Throbbing pains were most often provoked by sudden head movements and neck compression. He was healthy until the onset of these problems. The findings of all examinations were normal. The applied prophylactic therapy, typical for cluster headache, was without any effect. On 64-MSCT (multislice computed tomography), the neck arteries did not show any intraluminal pathology. The styloid processes were of normal length. On the left side, the styloid process tip pressed the internal carotid artery disturbing its longitudinal axis. CONCLUSION In our presentation, the defined lengths of the styloid processes were normal. The medial angulation of the left styloid process was more expressed reaching 63.5 degrees (the right side angulation was normal). Persistent and throbbing pain in the region of the left eye with backward projection suggested compression on the internal carotid artery. Pains were most frequently provoked by head turning and neck compression. 64-MSCT diagnostics enabled us to determine the characteristics of styloid processes and their relation to the internal carotid artery. Improvement was achieved by administration of anti-epileptic (gabapentin) and antidepressant (amitriptyline) drugs.

Compression of the cervical internal carotid artery by the stylopharyngeus muscle: an anatomical study with potential clinical significance

2010 ◽  
Vol 113 (4) ◽  
pp. 881-884 ◽  
Author(s):  
R. Shane Tubbs ◽  
Marios Loukas ◽  
Joshua Dixon ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Styloid Process ◽  
Elongated Styloid Process ◽  
Eagle Syndrome ◽  
Definition Of ◽  
Ica Stenosis ◽  
The Relationship

Object Occasionally, the internal carotid artery (ICA) may be symptomatically compressed in the neck by an elongated styloid process. The authors are unaware, however, of any study to date in which the aim was to describe the compression of this part of the ICA by surrounding muscles extending from the styloid process. Methods In 20 adult cadavers (40 sides), dissection of the cervical ICA was performed, with special attention given to the relationship between this artery and the stylopharyngeus muscle. In addition, rotation of the head was performed while observing for any compression of the ICA by this muscle. Last, the segment of the ICA immediately adjacent to the stylopharyngeus was excised and evaluated for signs of gross compression. Results Five sides (12.5%) were found to have an ICA that was grossly compressed by the neighboring stylopharyngeus muscle, and this was confirmed on excised ICA specimens. Moreover, such compression was increased with ipsilateral rotation of the head. Effacement of the lumen of the ICA by the stylopharyngeus ranged from approximately 30 to 50%. Such compression was increased by approximately 25% with ipsilateral rotation of the head. Conclusions To the authors' knowledge, compression of the cervical ICA by the stylopharyngeus muscle has not been previously described. Such a relationship should be appreciated by the clinician who treats patients with symptoms of ICA stenosis or occlusion as a potential extracranial site of compression. Based on this study, a subset of patients with occlusion of the cervical ICA but without elongation of the styloid process should be included within the definition of Eagle syndrome.

scholarly journals Eagle syndrome: A case report of stylocarotid syndrome with internal carotid artery dissection

2017 ◽  
Vol 23 (4) ◽  
pp. 433-436 ◽  
Author(s):  
Travis W Smoot ◽  
Ammar Taha ◽  
Nicholas Tarlov ◽  
Blake Riebe
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Rare Complication ◽  
Styloid Process ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Eagle Syndrome ◽  
Stylohyoid Ligament

Eagle syndrome is defined by an elongated styloid process or a calcified stylohyoid ligament that impinges on surrounding structures and causes a variety of symptoms. Classically, Eagle syndrome presents as neck, throat, or ear pain. The vascular variant, stylocarotid syndrome, can present as headache, transient ischemic attack, or stroke. Carotid artery dissection is a rare complication of stylocarotid syndrome. We report a case of stylocarotid syndrome in a 60-year-old man who presented with a right internal carotid artery (ICA) dissection and focal neurological deficits. Computed tomography with three-dimensional reformatting was used in the evaluation of his pathology. His dissecting right ICA was stented with subsequent symptom resolution. Improved recognition of the relationship between an elongated styloid or calcified stylohyoid ligament and symptomatology may lead to optimal etiology recognition and directed treatment.

Transcranial Doppler for Eagle Syndrome: Rare Presentation of Unilateral Internal Carotid Artery Compression by the Stylohyoid Ligament With Provocative Maneuvers

2018 ◽  
Vol 42 (1) ◽  
pp. 18-22
Author(s):  
Sara Skjonsberg ◽  
Mariah McLemore ◽  
Matthew P. Sweet ◽  
R. Eugene Zierler
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Internal Carotid ◽  
Left Middle Cerebral Artery ◽  
Head Positioning ◽  
Patient Reported ◽  
Eagle Syndrome ◽  
Stylohyoid Ligament

Eagle syndrome is a rare condition caused by compression of the internal carotid artery (ICA) or cranial nerves by an elongated styloid process or calcified stylohyoid ligament. This patient is a 56 year-old woman who presented with episodes of positional syncope for 8 years. Transcranial Doppler (TCD) demonstrated abnormally decreased flow in the left middle cerebral artery (MCA) during the syncopal episodes. The patient was evaluated by TCD, transcranial imaging (TCI), and carotid duplex (CD). First, a baseline CD and TCI were performed with the patient in a neutral position. TCD was then used during symptomatic provocative maneuvers to monitor the bilateral MCAs. Intraoperative TCD monitoring was also done during bilateral stylohyoid ligament resection, and postoperatively during the same provocative maneuvers. The baseline CD examination revealed normal extracranial carotid anatomy; TCD and TCI showed normal mean velocities and a normal anatomic variant of fetal origin of the left posterior cerebral artery. During provocative maneuvers, TCD showed abnormally dampened to absent flow in the left MCA, consistent with compression of the left extracranial ICA. CT scan confirmed elongated stylohyoid ligaments bilaterally. The MCA mean velocities were monitored intraoperatively and postoperatively by TCD and showed no changes with head positioning immediately following resection of the stylohyoid ligaments. The patient reported no syncopal episodes at follow-up 6 days after surgery. Although rare, Eagle syndrome should be considered as a cause of positional syncope. TCD can serve as a diagnostic test, an intraoperative monitoring tool, and a method for documenting the surgical outcome.

scholarly journals Dynamic assessment of internal carotid artery and elongated styloid process in a case of bilateral carotid artery dissection

2020 ◽  
Vol 11 ◽  
pp. 163
Author(s):  
Yoshinobu Horio ◽  
Kenji Fukuda ◽  
Koichi Miki ◽  
Noriko Hirao ◽  
Mitsutoshi Iwaasa ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Dynamic Assessment ◽  
Head Rotation ◽  
Styloid Process ◽  
Artery Dissection ◽  
Elongated Styloid Process ◽  
Bilateral Carotid ◽  
Eagle Syndrome

Background: Vascular Eagle syndrome is that an elongated styloid process causes ischemic stroke due to internal carotid artery (ICA) dissection. Dynamic assessment using radiological imaging has not been well investigated. We assessed the change in the relative positional relationship between the elongated styloid process and the ICA using a cone-beam computed tomography (CBCT). Case Description: A 46-year-old female presenting with disturbance of consciousness, right hemiparesis, and aphasia was admitted to our hospital. Initial CT analysis showed a bilateral elongated styloid process. Magnetic resonance angiography (MRA) showed occlusion of the left ICA and a near occlusion of the right ICA. MRA also revealed the intimal flap and intramural hematoma in the bilateral ICA. Digital subtraction angiography showed bilateral ICA occlusion and carotid artery stenting was performed subsequently. After that, we visualized the movement of carotid stent with CBCT fusion methods. The stent moved forward and backward at the attachment point of the styloid process during head rotation, and there was a possibility that mechanical stress was emphasized at this point. Styloidectomy was performed after her rehabilitation. The patient did not experience a recurrence of stroke. Conclusion: We showed that repeated attachment of the styloid process and ICA may trigger an ICA dissection during head rotation. This finding would be helpful for understanding the causes of vascular Eagle syndrome.

scholarly journals Role of Extradural Clinoidectomy and Optic Unroofing in Resection of an Anterior Clinoidal Meningioma with Encasement of the Internal Carotid Artery and Its Branches

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Zhaoliang Sun ◽  
Emel Avci ◽  
Mustafa K. Başkaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Vision Loss ◽  
Internal Carotid ◽  
Extent Of Resection ◽  
World Health ◽  
Who Grade ◽  
The Right ◽  
Supraclinoid Internal Carotid Artery

AbstractAnterior clinoidal meningiomas (ACMs) remain a major neurosurgical challenge. The skull base techniques, including extradural clinoidectomy and optic unroofing performed at the early stage of surgery, provide advantages for improving the extent of resection, and thereby enhancing overall outcome, and particularly visual function. Additionally, when the anterior clinoidal meningiomas encase neurovascular structures, particularly the supraclinoid internal carotid artery and its branches, this further increases morbidity and decreases the extent of resection. Although it might be possible to remove the tumor from the artery wall despite complete encasement or narrowing, the decision of whether the tumor can be safely separated from the arterial wall ultimately must be made intraoperatively.The patient is a 75-year-old woman with right-sided progressive vision loss. In the neurological examination, she only had light perception in the right eye without any visual acuity or peripheral loss in the left eye. MRI showed a homogeneously enhancing right-sided anterior clinoidal mass with encasing and narrowing of the supraclinoid internal carotid artery (ICA). Computed tomography (CT) angiography showed a mild narrowing of the right supraclinoid ICA with associated a 360-degree encasement. The decision was made to proceed using a pterional approach with extradural anterior clinoidectomy and optic unroofing. The surgery and postoperative course were uneventful. MRI confirmed gross total resection (Figs. 1 and 2). The histopathology was a meningothelial meningioma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence and has shown improved vision at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/vt3o1c2o8Z0

Sign in / Sign up

Export Citation Format

Share Document