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Case Reports
. 2022 Jun 28;14(6):e26403.
doi: 10.7759/cureus.26403. eCollection 2022 Jun.

Potential Surgical Implications of Internal Jugular Stenosis in a Craniocervical Junction Meningioma

Catherine Zhang  1 , Lauren Harris  1 , Hamza Itum  1 , Sanjiv Chawda  2 , Julian Coker  3 , Jonathan Pollock  1 , Ahmed-Ramadan Sadek  1 , Alireza Shoakazemi  1
Affiliations
Case Reports

Potential Surgical Implications of Internal Jugular Stenosis in a Craniocervical Junction Meningioma

Catherine Zhang et al. Cureus. .

Abstract

We report a case of a 61-year-old lady presenting with several weeks of progressive left-sided weakness, and found to have a foramen magnum meningioma. She was counselled on surgical resection of the tumour, and a preoperative computed tomography angiogram (CTA) was obtained for operative planning purposes. CTA demonstrated incidental bilateral internal jugular vein (IJV) stenosis, with enlarged extracranial collateral vessels and elongated styloid processes. The main surgical concern was potential injury of the extracranial collateral vessels during operative exposure, which may compromise her intracranial venous outflow in light of the IJV stenosis. A doppler ultrasound scan of the IJVs was performed, which demonstrated that blood flow was still present through both vessels. Through careful soft tissue dissection during surgery, potential complications and injury to the extracranial collaterals were avoided. We performed a literature review of the incidence of IJV stenosis, its associated conditions, and potential surgical implications. Complications from injury to vital collateral extracranial vessels should be considered during preoperative planning in patients with anatomical variants or risk factors for IJV stenosis, as seen in this case.

Keywords: craniocervical junction; eagle syndrome; internal jugular vein stenosis; meningioma; posterior cervical surgery.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Post-contrast sagittal (A) and axial (B) MRI scans.
The scans demonstrating a 23×16×22 mm intradural, extramedullary lesion with medullary and upper cervical cord compression.
Figure 2
Figure 2. Coronal view of CT angiogram.
The scans demonstrating bilateral narrowing of IJVs at the junction between the styloid processes and C1 lateral mass (arrows) (A). Large, tortuous, engorged anastomotic venous plexus crossing the midline, with collaterals to the posterior jugular vein and bilateral vertebral veins (B). IJV: internal jugular vein
Figure 3
Figure 3. Right (A) and left (B) internal jugular vein doppler ultrasound showing normal venous flow.
Figure 4
Figure 4. Intraoperative findings of a firm extra-axial tumour with a clear arachnoid plane indenting the cerebellar tonsils, hemisphere and brainstem.
Figure 5
Figure 5. Postoperative MRI scan.
The scans in sagittal (A) and axial (B) planes showing gross-total resection.
See this image and copyright information in PMC

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