Styloidogenic Jugular Venous Compression Syndrome: A Rare Vascular Variant of Eagle Syndrome.

background and importanceStyloidogenic jugular venous compression syndrome, a recently recognized vascular variant of Eagle syndrome, a rare condition caused by the elongation of the styloid process or calcification of the stylohyoid ligament, occurs when the internal jugular vein is compressed between the styloid process and C1 transverse process, leading to a spectrum of neurovascular and cervicofacial symptoms. CLINICAL PRESENTATION: A 46-year-old male pilot presented with right-sided pulsatile tinnitus, vertigo, and episodic near-syncope that progressively worsened over 4 years despite multiple interventions. Computed tomography and MRI revealed an elongated right styloid process (approximately 35 mm) compressing the internal jugular vein against the C1 transverse process. The patient underwent a right-sided styloidectomy with partial resection of the C1 transverse process by a transcervical approach. The facial and spinal accessory nerves were preserved, and postoperative recovery was uneventful. By postoperative day 2, the patient reported near-complete resolution of tinnitus and pain, with sustained improvement at 1-month follow-up.

conclusionStyloidogenic jugular venous compression syndrome should be considered for patients with pulsatile tinnitus or symptoms of impaired cerebral venous outflow. Computed tomography venography is considered the diagnostic gold standard. Surgical decompression through styloidectomy with C1 resection can provide effective and durable symptom relief. Early diagnosis and surgical management can result in excellent outcomes.