UNASSIGNED: Eagle syndrome is caused by an elongated styloid process affecting carotid arteries and cranial nerves. Pain, dysphagia, tinnitus, paresthesia (classic subtype), and neurovascular events (vascular subtype) may be triggered by head movements or arise spontaneously. However, Eagle syndrome remains underappreciated in the neurological community. We aimed to determine the most common neurological and non-neurological clinical presentations in patients with Eagle syndrome and to assess the clinical outcome post-surgical resection in comparison to non-surgical therapies.
UNASSIGNED: We conducted a systematic review of patient-level data on adults with Eagle syndrome, following PRISMA guidelines. We extracted data on demographics, presenting symptoms, neurological deficits, radiological findings, and treatments, including outcomes and complications, from studies in multiple indexing databases published between 2000 and 2023. The study protocol is registered with PROSPERO.
UNASSIGNED: In total, 285 studies met inclusion criteria, including 497 patients with Eagle syndrome (mean age 47.3 years; 49.8% female). Classical Eagle (370 patients, 74.5%) was more frequent than vascular Eagle syndrome (117 patients, 23.5%, p < 0.0001). Six patients (1.2%) presented with both variants and the subvariant for four patients (0.8%) was unknown. There was a male preponderance (70.1% male) in the vascular subtype. A history of tonsillectomy was more frequent in classic (48/153 cases) than in vascular (2/33 cases) Eagle syndrome (Odds Ratio 5.2, 95% CI [1.2-22.4]; p = 0.028). By contrast, cervical movements as trigger factors were more prevalent in vascular (12/33 cases) than in classic (7/153 cases) Eagle syndrome (Odds Ratio 7.95, 95% CI [2.9-21.7]; p = 0.0001). Headache and Horner syndrome were more frequent in vascular Eagle syndrome and dysphagia and neck pain more prominent in classic Eagle syndrome (all p < 0.01). Surgically treated patients achieved overall better outcomes than medically treated ones: Eighty-one (65.9%) of 123 medically treated patients experienced improvement or complete resolution, while the same applied to 313 (97.8%) of 320 surgical patients (Odds Ratio 1.49, 95% CI [1.1-2.0]; p = 0.016).
UNASSIGNED: Eagle syndrome is underdiagnosed with potentially serious neurovascular complications, including ischemic stroke. Surgical treatment achieves better outcomes than conservative management. Although traditionally the domain of otorhinolaryngologist, neurologist should include this syndrome in differential diagnostic considerations because of the varied neurological presentations that are amenable to effective treatment.

Objectives: Transoral robotic surgery (TORS) is gaining popularity and has been introduced for the treatment of Eagle syndrome. This review aims to evaluate the safety and efficacy of TORS for the treatment of Eagle syndrome. Methods: A systematic review of the English language literature using multiple databases was completed for studies describing TORS for Eagle syndrome. The quality of studies and risk of bias were evaluated using the MINORS scoring system. Results: Out of 1495 articles screened, 4 studies met criteria for inclusion in the final analysis. Across all studies, there was a 100% surgical success rate. In total, every patient had some level of symptom improvement with 84% of patients having complete symptom improvement and 16% having partial improvement. Reported estimated blood loss averaged 12.5 mL. A total of 94.7% of patients had no surgical complications and no cases were complicated by postoperative bleeding. Operative time averaged 65 minutes. The average length of stay was 2.1 days. A total of 92% of patients resumed their diet on postoperative day 1, with the remainder resuming on postoperative day 2. MINORS criteria scoring suggested moderate risk of bias in all studies. Conclusion: Based on limited quality evidence, this review suggests that TORS is a safe and effective surgical approach in the treatment of Eagle syndrome with low complication rates. Further large-scale prospective studies are warranted.

OBJECTIVE: The aim of the study is to conduct a systematic review of the existing literature on styloidectomy performed through transoral robotic surgery (TORS) in Eagle syndrome (ES).
METHODS: Two independent reviewers (RC and AC) conducted a systematic review of PubMed and Embase databases, seeking articles on TORS performed for ES treatment. The search was conducted in July 2023. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
METHODS: The review included a total of 17 adult patients, comprising 12 females and 5 males, with an average age of 52.2 years, all diagnosed with ES.
METHODS: For each patient, we assessed the overall length of the styloid process, the affected side, total intervention duration, hospitalization duration, pre and postoperative Visual Analogue Scale (VAS) scores, and the presence of minor and major complications.
RESULTS: We identified 4 articles describing 17 instances of TORS as a surgical treatment for ES in the literature, totaling 18 styloidectomies. The mean age of the patients was 52.2 years, with 12 females and 5 males. The average operation time, inclusive of the docking phase, was 68.8 minutes. Sixteen patients (94.1% of the total) experienced complete symptom disappearance or near-complete resolution after surgery. One patient (5.9%) showed improvement categorized as \'non-meaningful.\' Only one case of minor complication was reported among the 17 procedures (5.9%).

UNASSIGNED: 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.
UNASSIGNED: 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.\"
UNASSIGNED: 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.
UNASSIGNED: 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.

BACKGROUND: Abnormal styloid processes cause dissection of supra-aortic arteries in some cases. In total, about 33 cases have been described in the world and national literature. However, there were no dissections associated with neurosurgery. At the same time, anomalies of styloid process may be an unidentified cause of many spontaneous dissections of brachiocephalic arteries.
OBJECTIVE: To analyze modern data on dissection of brachiocephalic arteries associated with anomalies of styloid process and describe dissection in a 44-year-old patient with deviated styloid processes after posterior cranial fossa surgery.
METHODS: Searching for literature data was performed using the keywords \"dissection of the cervicocerebral arteries\", \"dissection of the brachiocephalic arteries\", \"stylocarotid syndrome\" and \"Eagle syndrome\" in the PubMed and Medscape databases. We also describe a patient hospitalized for microsurgical resection of cystic-solid hemangioblastoma of medulla oblongata who developed postoperative dissection of both internal carotid and vertebral arteries.
RESULTS: We found 1777 papers between 01/01/1900 and 01/18/2021. In most cases, ICA dissection was not a result of stylocarotid syndrome. There were 121 full-text Russian- or English-language articles. We selected 46 most relevant publications. Analyzing these papers, we found that small distance between the tops of styloid processes and internal carotid arteries can be a risk factor of dissection of brachiocephalic arteries in addition to styloid process elongation. Our patient was diagnosed with just such an anomaly.
CONCLUSIONS: Anomalies of styloid processes can cause dangerous vascular complications. Therefore, the length and abnormal deviation of styloid process should be considered when planning intraoperative position of a patient associated with prolonged neck flexion.
Аномалии шиловидного отростка могут быть причиной диссекции брахиоцефальных артерий. Всего в мировой и отечественной литературе описано 33 подобных случая, но ни одного, связанного с нейрохирургической операцией.
UNASSIGNED: Выполнить обзор современных публикаций, посвященных диссекции брахиоцефальных артерий, обусловленной аномалиями шиловидного отростка. Привести описание клинического наблюдения диссекции брахиоцефальных артерий, возникшей после операции в области задней черепной ямки у 44-летней пациентки с искривленными шиловидными отростками.
UNASSIGNED: Проведен поиск публикаций с применением ключевых слов «dissection of the cervicocerebral arteries», «dissection of the brachiocephalic arteries», «stylocarotid syndrome», «Eagle syndrome» в базах PubMed и Medscape. Представлены данные пациентки, госпитализированной для микрохирургического удаления кистозно-солидной гемангиобластомы продолговатого мозга, у которой после операции развилась диссекция обеих внутренних сонных и позвоночной артерий.
UNASSIGNED: За период с 01.01.1900 по 18.01.2021 обнаружено 1777 источников, удовлетворяющих поисковому запросу. В большинстве из них диссекция внутренней сонной артерии развивалась не в результате шилокаротидного варианта синдрома Игла. Для полноценного анализа доступна 121 работа, полнотекстовые версии которых опубликованы на русском или английском языках. Из этого числа отобраны 46 наиболее релевантных публикаций. При анализе публикаций выявлено, что провоцирующим фактором для развития диссекции брахиоцефальных артерий могут выступать не только удлиненные шиловидные отростки, но и малое расстояние между их верхушками и внутренними сонными артериями. У представленной пациентки выявлена именно такая аномалия.
UNASSIGNED: Аномалии шиловидных отростков могут стать причиной опасных сосудистых осложнений, поэтому следует обращать внимание на длину и патологическое отклонение шиловидного отростка при планировании положения пациентов на операционном столе во время оперативных вмешательств, сопряженных с длительным сгибанием шеи.

Vascular compression syndromes include a group of rare vascular changes due to extrinsic compression of veins or arteries by surrounding structures. These pathologies are often underestimated due to their rarity, clinicians\' poor level of knowledge, and the non-specificity of their symptoms. The best known are Eagle syndrome, thoracic outlet syndrome, nutcracker syndrome, May-Thurner syndrome, Dunbar syndrome, and popliteal entrapment syndrome. This work summarizes the main ultrasonographic characteristics, symptoms, and treatments of choice for these syndromes. Knowledge of these conditions\' characteristic signs is essential for the differential diagnosis. Failure to diagnose these rare diseases can expose patients to serious complications and risks to their health.

Styloidogenic jugular venous compression syndrome has been recently described as a new cause of idiopathic intracranial hypertension. We present a 69-year-old patient, without other relevant medical history, presenting with 3 years of positional headache associated with decreased vision when reading and while turning her head to the right or left. She also reported pulsatile low-frequency tinnitus. Papilloedema was noted on the physical examination and, on imaging, an enlarged styloid process that induced jugular vein compression. The patient underwent styloidectomy with resolution of her symptoms and normalisation of her visual fields.

BACKGROUND: Eagle syndrome occurs when elongated styloid process or ossification of the stylohyoid ligament interfere with the surrounding anatomical structures giving rise to various symptoms. Watt W. Eagle identified two types: stylo-hyoid classic syndrome and stylo-carotid artery syndrome. The aim of this systematic review of the literature is to evaluate correlations between Eagle syndrome and traumatic events or teeth extractions.
METHODS: out of 294 articles, the final study allowed the identification of 13 studies focusing on traumatic events. Out of 342 articles, the final study allowed the analysis of two studies regarding extractive dental events.
RESULTS: 13 articles showed correlations between the onset of symptoms in Eagle syndrome and traumatic events and highlighted two possibilities: traumatic event could fracture the already elongated styloid process or calcified stylohyoid ligament; trauma itself triggers the pathophysiological mechanisms that lead to lengthening of styloid process or calcification of stylohyoid ligament and therefore the typical symptoms. The only two case reports concerning Eagle syndrome symptoms after extractive dental events describe the onset of classic type.
CONCLUSIONS: The analyzed articles confirm correlation between traumatic event and onset of typical symptoms of Eagle syndrome. There is not enough literature linking extractive dental events to Eagle syndrome.
BACKGROUND: CRD42020185176.

BACKGROUND: Internal jugular vein stenosis (IJVS), characterized by a series of clinical manifestations, such as head and neck symptoms, visual and ear symptoms, as well as sleep disorder, has been receiving attention in recent years. However, its\' etiologies are not fully understood.
METHODS: We report a cases series of IJVS induced by styloid oppression. We define it as the stylo-jugular type of Eagle syndrome (ES).
CONCLUSIONS: Our study reveals that external oppression, especially by styloid process, is an important etiology of IJVS. The stylo-jugular ES diagnosis can be identified by Computed tomography venography. Whether stylo-jugular ES can be corrected by styloidectomy requires further investigation.

The styloid or Eagle syndrome is characterized by recurrent episodes of pharyngeal pain irradiating in various additional sites of head and neck, owing to an elongated stylohyoid process or calcification of stylohyoid ligament or complex. This article aimed to report a case of surgical treatment of Eagle syndrome by applying transcervical approach for styloidectomy, after a previous but failed intraoral attempt. Aside from the description of the surgical steps of this technique, the current literature was reviewed too. Subsequently to the operation, the patient cited significant resolution of symptomatology from the first postoperative week and remained pain-free the following 6 months. After this follow-up period, the esthetic outcome of the external scar was very satisfactory, without other complications. If not properly diagnosed, patients with Eagle syndrome may receive ineffective or unsuccessful treatments. Secondary to failed intraoral attempt, which results in an elongated residual stump, it is advisable to use transcervical approach for successful resection of the stylohyoid process. In the presented case, the establishment of both adequate exposure and control of neurovascular injury was preoperatively considered essential for dissection in a previously operated field. The selection of either transcervical or intraoral approach is a surgeon-dependent decision, which relies on surgeon\'s experience, skills, and available equipment and may be influenced by the patient\'s expectations. Despite the reported disadvantages of transcervical approach, various modifications of this technique have lessened the possible morbid consequences.