Internal Jugular Vein Fenestration: An Intraoperative Finding Without a Radiological Clue

Abstract

A comprehensive understanding of the anatomical variations of the internal jugular vein (IJV) is essential to prevent inadvertent injuries during neck procedures, particularly neck dissection. In addition, its relationship with the spinal accessory nerve in the upper part of the neck is relatively variable. IJV fenestration refers to bifurcation of the vein with reunion proximal to the subclavian vein, whereas IJV duplication refers to continued branching till joining the subclavian vein separately. We report a case of a fenestrated IJV identified intraoperatively with the spinal accessory nerve passing laterally to both divisions.

Keywords: anatomical anomalies; duplication; fenestration; internal jugular vein; neck dissection; split.

Figure 1. Fenestration of the left IJV

Intraoperative appearance of the left neck with fenestrated IJV after neck dissection was completed. The common facial vein (C) is clipped and divided. S, spinal accessory nerve; A, ansa cervicalis. The asterisk refers to the window (fenestration). IJV, internal jugular vein.

Figure 2. Contrast-enhanced MRI.

A contrast-enhanced MRI, axial view, showing completely non-visualized left IJV that is compressed by the mass. The right IJV (black arrow) and left external jugular vein (red arrow) can be seen. IJV, internal jugular vein.