Case of Drs. Eytan Raz and Mark S. Persky
This controversial surgery is made more controversial by the fact that it is often done badly. The majority of C1 area jugular stenoses are NOT due to styloid process compression and styloidectomy alone does little or nothing. Achieving desired results requires shaving of C1 lateral mass.
Below is a beautiful case of how to do it right — with intraoperative angiography and careful surgical technique
Clinical presentation is withheld for privacy purposes — lets just say that we choose these cases extremely carefully
Pressure gradients are important — a gradient of 5 mm Hg was recorded across the extrinsic stenosis
NOTE that there is almost always some degree of compression there — and nearly always asymptomatic. Below is a beautiful 3D DSA venous phase of a normal case by Dr. Eytan Raz
Again, the above is a different, normal asymptomatic situation.
Back to our case — intraoperative angiography — in a dedicated hybrid angio/OR suite. Axial 3D DSA set post right styloid removal — as you can see, it changes nothing. The right jugular is still occluded
Reconstructions show relationship to C1 lateral mass and arterial systems
Back to our case: intraopearative 3D DSA Post C1 lateral mass resection — now there is a difference
Delayed postop angio
Moral — the role of this surgery would be better and faster established if it were adequately performed. Otherwise, judging outcomes is impossible