Internal jugular vein

Paired vein collecting the blood from the brain, the superficial parts of the face, and the neck. An internal jugular vein is a type of jugular vein.

Idiopathic intracranial hypertension, also known as pseudotumor cerebri, often presents with severe headache and associated vision loss. Venous outflow obstruction has been noted as a prominent etiologic factor in many cases, and previous anatomic studies have shown that the internal jugular vein at the skull base can be prone to compression by the neighboring bony structures.

Fritch et al. presented a case of a 13-yr-old male with multifactorial intracranial hypertension including compression of the IJ vein by the transverse process of C1. Computerized tomography angiographic imaging revealed bilateral stenosis of the IJ veins due to compression from the transverse processes of C1. Medical management and shunt were attempted without resolution of symptoms. Hemodynamically significant stenosis at the right IJ was confirmed with manometry and so the C1 transverse process was resected and a stent placed endovascularly with a resolution of pressure gradient and clinical symptoms.

Contribution of C1 compression to this patient's intracranial hypertension suggests that evaluation for IJ compression below the skull base may be needed to identify the underlying cause of intracranial hypertension in certain patients. Furthermore, surgical decompression of the IJ vein may be required as part of the treatment strategy. If venous stenting is being considered, this decompressive step must be taken before stenting is performed. Fritch et al. offer this case as evidence that decompression of the IJ vein by C1 lateral mass resection can be an effective and novel technique in the repertoire of neurosurgical management of intracranial hypertension 1).

2) 3)

Internal jugular vein stenosis (IJVS) is characterized as a series of non-specific symptoms, including head symptoms (headache, head noise, dizziness, and memory decline), eye symptoms (eye bloating, diplopia, blurred vision, and visual field defect), ear symptoms (tinnitus and high-frequency hearing decline), neck discomfort, or sleeping disorder

Imaging features in addition to clinical symptoms can be used to differentiate between physiologic IJV slenderness and pathologic IJV stenosis. Notable imagine-defining features for IJV stenosis include local stenosis surrounded by abnormal venous collaterals, cloudy-like WMHs, and mismatch between the transverse diameter of IJV and the caliber of the jugular foramina 4)

Fritch C, Voronovich Z, Carlson AP. C1 Transverse Process Resection for Management of Jugular Stenosis [published online ahead of print, 2020 Mar 17]. Oper Neurosurg (Hagerstown). 2020;opaa032. doi:10.1093/ons/opaa032
Scerrati A, Zamboni P, De Bonis P. Letter: C1 Transverse Process Resection for Management of Jugular Stenosis [published online ahead of print, 2020 Jul 6]. Oper Neurosurg (Hagerstown). 2020;opaa200. doi:10.1093/ons/opaa200
Brunozzi D, Alaraj A. Commentary: C1 Transverse Process Resection for Management of Jugular Stenosis [published online ahead of print, 2020 Apr 13]. Oper Neurosurg (Hagerstown). 2020;opaa071. doi:10.1093/ons/opaa071
Wang M, Wu X, Lan D, Zhou D, Ding Y, Ji X, Meng R. Differentiation between anatomical slenderness and acquired stenosis of the internal jugular veins. CNS Neurosci Ther. 2022 Aug 2. doi: 10.1111/cns.13924. Epub ahead of print. PMID: 35919952.
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