Interventional and surgical management of internal jugular venous stenosis: a narrative review

Abstract

BackgroundA small subset of patients with presumed idiopathic intracranial hypertension are found to have isolated internal jugular vein stenosis (IJVS).ObjectiveTo review the current interventions used in patients who present with intracranial hypertension secondary to IJVS.MethodsIn December 2020, we performed a literature search on Pubmed/Medline and Scopus databases for original articles studying surgical and endovascular interventions used for intracranial hypertension in the setting of internal jugular vein stenosis. No date, patient population, or study type was excluded.ResultsAll studies that included at least one case in which a surgical or endovascular intervention was used to treat IJVS were included. Selection criteria for patients varied, most commonly defined by identification of compression of the internal jugular vein. The 17 studies included in this review ranged from case reports to large single-center cohort studies. The most used surgical intervention was styloidectomy. Styloidectomy had an overall better outcome success rate (79%) than angioplasty/stenting (66%). No complications were recorded in any of the surgical cases analyzed. Outcome measures varied, but all studies recorded clinical symptoms of the patients.ConclusionFew current large cohort studies analyze surgical and endovascular interventions for patients with IJVS. Notably, the most common intervention is styloidectomy, followed by internal jugular vein stenting. By understanding the trends and experience of interventionalists and surgeons, more focused and larger studies can be performed to determine effective strategies with the best clinical outcomes.

Differentiation between anatomical slenderness and acquired stenosis of the internal jugular veins

“…A previous study indicated that dehydration and medication could not be devoted to sustained improvement in the patient's symptoms from IJVS 5 . While endovascular stenting was considered as a useful therapy on correcting abnormal elevated ICP induced by venous sinus stenosis, evidence regarding stenting to correct IJV stenosis is still lacking 4,31,32 . Our study reported in 2018 confirmed that endovascular stenting could effectively correct IJV stenosis and remove IJV stenosis‐related symptoms and signs 11 .…”

“… 5 While endovascular stenting was considered as a useful therapy on correcting abnormal elevated ICP induced by venous sinus stenosis, evidence regarding stenting to correct IJV stenosis is still lacking. 4 , 31 , 32 Our study reported in 2018 confirmed that endovascular stenting could effectively correct IJV stenosis and remove IJV stenosis‐related symptoms and signs. 11 In this study we further confirmed the effect of endovascular stenting on correcting IJV stenosis by a small self‐controlled sample in the cohort of patients with IJV stenosis.…”

“…IJV stenosis is still lacking. 4,31,32 Our study reported in 2018 confirmed that endovascular stenting could effectively correct IJV stenosis and remove IJV stenosis-related symptoms and signs. 11 In this study we further confirmed the effect of endovascular stenting on correcting IJV stenosis by a small self-controlled sample in the cohort of patients with IJV stenosis.…”

“Idiopathic” intracranial hypertension: An update from neurointerventional research for clinicians

“…Intracranial venous hypertension can also be secondary to extracranial venous stenosis, specifically the internal jugular vein (IJV) (59). This can be in the setting of a congenitally diminutive IJV, or secondary to extrinsic compression, such as by the styloid process, a cervical rib, hypertrophic scale muscles, or the mastoid process (60,61). At present, there is limited evidence on the surgical treatment of intracranial venous congestion secondary to internal jugular vein stenosis, with no randomized trial data as of yet.…”

Cerebral venous anatomy: implications for the neurointerventionalist

“…The paucity of systematic studies invites future thoughtful investigation. 54 The condylar system is a major source of physiologic outflow, especially in non-supine positions figure 1 and figure 12A-F). 51 55 Its prominence varies, and is usually greater with C1 level jugular narrowing (figure 12D-F).…”