PROCESSO ESTILOIDE ALONGADO NAS RADIOGRAFIAS PANORÂMICAS EM UMA SUBPOPULAÇÃO

Styloid process elongation associated with symptoms such as cervicofacial pain, tinnitus and otalgia is called Eagle Syndrome. The objective of this study is to assess the presence of elongated styloid process through panoramic radiographs, in a subpopulation of the State of Para, Brazil, as to age and sex. Panoramic radiographs were selected and the apparent size of the styloid process was measured from the point where the styloid leaves the tympanic plate to the lower tip of the process. Data were analyzed by means of chi-square tests and the “t” test with a significance level of 5%. Forty-three percent of all elongated styloid processes were observed in patients aged between 18 and 35 years old. Of these styloid processes measuring more than 30 mm, there were 815 that showed a Type I elongation pattern, being 98 that showed a Type II calcification pattern and 92 showed a Type III calcification pattern. It is concluded that the Type I elongated styloid process was the most frequent, but no statistically significant correlation was found between the presence of the elongated styloid process and the studied variables.

The eagle jugular syndrome as the cause of delayed intracranial hemorrhage after microvascular decompression for hemifacial spasm: A case report

Background: Eagle syndrome is a rare disorder whereby an elongated styloid process (ESP) causes not only some otolaryngological symptoms, but also cerebrovascular events caused by compression of the carotid artery. In recent years a syndrome, denominated as Eagle jugular syndrome, involving internal jugular vein (IJV) compression caused by an ESP has been proposed as a variation of Eagle syndrome. Clinical impact of the Eagle jugular syndrome on neurosurgical procedures has not been reported yet. Case Description: We present a case of a 68-year-old woman who underwent microvascular decompression for hemifacial spasm of the left side and developed delayed intracranial hemorrhage on postoperative day 3. We also demonstrate that this patient developed ipsilateral IJV stenosis between an ESP and the muscle bundle of the rectus capitis lateralis with antero-flexion neck position, which would induce venous congestion in addition to surgical disruption of emissary vein. Conclusion: This case is the first report demonstrating the association of an ESP with postoperative delayed intracranial hemorrhage. Our report elucidates the importance of the awareness among neurosurgeons of considering the ESP as an important bony anomaly, especially when planning for posterior fossa surgery.

Abstract 1122‐000020: Assessing Correlation Between Styloid Length and Internal Carotid Artery Dissection in EAGLE Syndrome Patients

Introduction : Eagle Syndrome (ES) also known as styloid–carotid artery syndrome is a caused by elongation of the styloid process or calcification of the stylohyoid ligament. Usually, normal stylohyoid process is 2.5 cm in length. However, it is classified as an elongated styloid process if its length is more than 2.5 cm. Carotid Artery dissection which is a significant cause of ischemic stroke in all age groups is a known rare complication of ES. Goal of our study is to assess for correlation between degree of styloid process lengthening and grades of Carotid and Vertebral Dissections in adult population. Methods : Retrospective database review of adult patients with known cervical dissections (traumatic and non‐traumatic) were analyzed from Level I Comprehensive Stroke Center. Patients in pediatric age group (less than age 18 years) were excluded. Deidentified patient information including patient’s age, demographics, past medical history, mechanism of injury (if applicable) prior to initial clinical presentation, initial clinical presentation, methodology for diagnosis of cervical dissection (Internal Carotid vs External Carotid vs Vertebral Arteries) along with measurements of stylohyoid ligaments and degrees of dissections bilaterally were retrieved and analyzed. Data analysis was performed by using IBM SPSS Statistics Software 28.0. Results : Total number of patients were 111 (N). Mean age of patients was 52.97 (±16 years). Demographic distribution: African Americans (47/111), Caucasians (62/111) and Others (2/111). Gender distribution: Males (55/111) and Females (56/111). Mechanisms of injury based on available data were as follows: Mechanical Fall (21); MVC (21) and other mechanisms (12). 43/111 patients did have a headache as compared to 68/111 who did not during initial clinical presentation. Imaging confirmation for arterial dissection was performed via MRA (6/111); CTA (98/111) and DSA (7/111). Average styloid length for patients with Eagle syndrome was 3.1 cm vs non‐Eagle group which was 2.38 cm. In Non‐Eagle Syndrome group (Styloid length <2.5 cm), average grades of arterial dissections were as follows: Left Vertebral Artery dissection‐2.1; Left Internal Carotid Artery‐2.1; Right Internal Carotid Artery‐0.40 and Right Vertebral Artery‐2.5. For Eagle Syndrome patients (Styloid length >2.5 cm), average grade of arterial dissections were as follows: Left Vertebral Artery‐2.6; Left Internal Carotid Artery‐3.38; Right Internal Carotid Artery dissection‐2.3 and Right vertebral artery dissection‐1. Based on statistical analysis (paired samples T‐test), styloid length of more than 2.5 cm was significantly correlated with left internal carotid artery dissection (p value 0.012; p<0.05***). For dissections in other arteries including Right Internal Carotid (p value 0.91), Right Vertebral (p value 0.12) and Left vertebral (p value 0.488) no statistical significance was found when both groups were compared. Conclusions : From our study we can conclude that in patients with EAGLE syndrome styloid length more than 2.5 cm is significantly correlated with higher risk of Left Internal Carotid Artery dissection.

Eagle’s Syndrome as a Cause of Discomfort and the Subjective Presence of a Foreign Body in the Throat

Eagle syndrome consists of symptoms resulting from the elongation and excessive calcification of the styloid process of the temporal bone and calcification of the ligaments associated with this process. The main symptoms of this syndrome are the feeling of a foreign body in the throat, dysphagia and pain localized in the temporomandibular region, neck and ear. The authors describe the case report of a previously healthy 39-year-old Caucasian male that complained of discomfort and foreign body sensation in his throat. Computed tomography (CT) showed the presence of an elongated styloid process bilaterally with clear predomination at the left side. The patient underwent laryngological and surgical consultation. Due to the lack of symptoms related to the compression of the carotid arteries, no surgery was recommended. In summary, Eagle’s syndrome is a rare condition characterized by craniofacial pain or foreign body sensation that should be considered, especially if the pain is unilateral. CT imaging in his case was a perfect tool and enabled a suitable diagnosis of this rare syndrome.