Styloidectomy for Jugular Decompression in Venous Outflow Disorders

Background: Jugular venous stenosis at the level of C1 and the styloid process is increasingly implicated in cerebral venous outflow disorders, often presenting with headache, pulsatile tinnitus, and cognitive complaints. Although small studies suggest benefit from open decompression via styloidectomy, larger series are needed to clarify outcomes and complication profiles. Methods: A single-center, retrospective review was performed evaluating patients who underwent styloidectomy with or without partial C1 resection for symptomatic jugular stenosis between 2022 and 2024. Inclusion criteria included refractory neurologic symptoms, imaging-confirmed internal jugular vein (IJV) compression, and dynamic venographic evidence of elevated jugular gradients. Baseline characteristics, perioperative data, and short- and long-term outcomes were assessed. Results: Forty-one patients (87.8% female; mean age, 45.4 years) were included in the study. Postoperatively, 29 patients (70.7%) reported symptomatic improvement, defined as subjective relief of baseline symptoms and/or reduction in Cerebral Venous Disorders Severity Scores, whereas 12 (29.3%) did not. Among patients with Cerebral Venous Disorders Severity Scores, the mean reduction was 1.83 points. The mean follow-up was 136 days. Short-term complications included cranial nerve VII palsy (two patients; one with temporary apraxia and one with severe nerve injury) and minor IJV injury (one patient). Long-term but temporary complications occurred in 23 patients (56.1%)—primarily transient shoulder pain, numbness, or swallowing difficulty—which typically resolved within 3 months. Two patients (4.9%) experienced marginal mandibular nerve palsies. Over one third elected for additional surgical intervention, including contralateral surgery or stenting. Conclusions: Styloidectomy appears effective in selected patients with symptomatic IJV compression, with most reporting meaningful relief. However, complications are common, and many patients require further intervention. Careful diagnostic evaluation and patient selection remain critical as the role of open decompression in cerebral venous disorders continues to evolve.