The eagle jugular syndrome as the cause of delayed intracranial hemorrhage after microvascular decompression for hemifacial spasm: A case report

BACKGROUND: Eagle syndrome is a rare disorder whereby an elongated styloid process (ESP) causes not only some otolaryngological symptoms, but also cerebrovascular events caused by compression of the carotid artery. In recent years a syndrome, denominated as Eagle jugular syndrome, involving internal jugular vein (IJV) compression caused by an ESP has been proposed as a variation of Eagle syndrome. Clinical impact of the Eagle jugular syndrome on neurosurgical procedures has not been reported yet. CASE DESCRIPTION: We present a case of a 68-year-old woman who underwent microvascular decompression for hemifacial spasm of the left side and developed delayed intracranial hemorrhage on postoperative day 3. We also demonstrate that this patient developed ipsilateral IJV stenosis between an ESP and the muscle bundle of the rectus capitis lateralis with antero-flexion neck position, which would induce venous congestion in addition to surgical disruption of emissary vein. CONCLUSION: This case is the first report demonstrating the association of an ESP with postoperative delayed intracranial hemorrhage. Our report elucidates the importance of the awareness among neurosurgeons of considering the ESP as an important bony anomaly, especially when planning for posterior fossa surgery.