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Review
. 2023 Nov 3:14:389.
doi: 10.25259/SNI_666_2023. eCollection 2023.

Eagle syndrome: An updated review

Serena Pagano  1 , Vittorio Ricciuti  2 , Fabrizio Mancini  3 , Francesca Romana Barbieri  1 , Fabrizio Chegai  4 , Alessandra Marini  3 , Daniele Marruzzo  1 , Riccardo Paracino  3 , Riccardo Antonio Ricciuti  1
Affiliations
Review

Eagle syndrome: An updated review

Serena Pagano et al. Surg Neurol Int. .

Abstract

Background: This work aims to review the current literature and our experience on vascular Eagle syndrome (ES) that can present misleading clinical presentations and better understand the possible therapeutic strategies.

Methods: We reviewed the existing literature on PubMed from January 1, 2017, to December 31, 2022, including the sequential keywords "vascular AND Eagle syndrome," "vascular AND styloid syndrome," "vascular AND elongated styloid process," "vascular AND stylocarotid syndrome," and "Eagle syndrome AND carotid artery dissection."

Results: 38 vascular ES cases, including our experience, were analyzed. The most frequent clinical onset was hemiparesis (n 21, 57%), but other regular clinical presentations were aphasia, loss of consciousness, amaurosis, headache, or a combination of the latter. Massive oral bleeding was reported only once in the literature before our case. Twelve patients were treated with only antiplatelet therapy, either single or double. Nine patients were treated with anticoagulation therapy only. In 14 patients, a carotid artery stent was used, associated with anticoagulation or antiplatelet therapy. In 17 cases, a styloid process (SP) resection was performed.

Conclusion: ES has many clinical presentations, and carotid artery dissection resulting in oral bleeding seems rare. Literature results and our experience make us believe that when dealing with vascular ES, the best treatment strategy is endovascular internal carotid artery stenting with antiplatelet therapy, followed by surgical removal of the elongated SP to prevent stent fracture.

Keywords: Eagle syndrome; Elongated styloid process; Internal carotid artery dissection; Stylocarotid syndrome; Vascular Eagle syndrome.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Preferred reporting items for systematic reviews and meta-analyses graph shows paper selection method.
Figure 2:
Figure 2:
(a and b) Coronal and sagittal computed tomography (CT) scans show the elongated left styloid process causing internal carotid artery compression. (c) The axial CT scan showed hypodense tissue in the left retropharyngeal space with poor enhancement and diameters of about 5 × 3 cm.
Figure 3:
Figure 3:
(a and b) A small bleb about 3 mm in size is shown, located at the top III left internal carotid artery at the height of the apex of the temporal style process.
Figure 4:
Figure 4:
(a and b) Lateral angiography of the left carotid artery shows the placement of the flow-diverter device (Streamline 5 mm × 25 mm). (c) One month computed tomography scan shows stent placement with no complications.
Figure 5:
Figure 5:
(a) The echo-color-Doppler examination of the left internal carotid artery documents the presence of the flow-diverter stent, which appears in the correct position and patent with an intra-stent sampled velocity index in range. (b) Postoperative 3D reconstruction computed tomography scan; reducing the styloid process length avoids impingement with the stent.
See this image and copyright information in PMC

References

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