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      Elongated styloid process as a possible cause of distal carotid artery dissection after carotid endarterectomy using indwelling shunt: A case report

      case-report

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          Abstract

          Background:

          A dissection beginning from a point distal to the endpoint of the carotid endarterectomy (CEA) is called distal carotid artery dissection (CAD), which is known as one of the significant surgical complications of CEA.

          Case Description:

          We present a case of distal CAD as a perioperative complication after CEA using indwelling shunt. We estimated this pathophysiology to be caused by the mechanical conflict of the inflated balloon with the elongated styloid process.

          Conclusion:

          Since a distal CAD can cause severe, irreversible neurological deficits, preoperative assessment of the styloid process should be routinely performed in CEA.

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          Most cited references17

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          Symptomatic elongated styloid process; report of two cases of styloid process-carotid artery syndrome with operation.

          Michael Eagle (1949)
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            The cause of perioperative stroke after carotid endarterectomy.

            Thomas Riles, Anthony M. Imparato, Glenn Jacobowitz … (1994)
            The purpose of this study was to examine the cause of perioperative stroke after carotid endarterectomy. The records of 2365 patients undergoing 3062 carotid endarterectomies from 1965 through 1991 were reviewed. Sixty-six (2.2%) operations were associated with a perioperative stroke. The mechanism of stroke was determined in 63 of 66 cases. Patient risk factors and surgeon-dependent factors were analyzed. More than 20 different mechanisms of perioperative stroke were identified, but most could be grouped into broad categories of ischemia during carotid artery clamping (n = 10), postoperative thrombosis and embolism (n = 25), intracerebral hemorrhage (n = 12), strokes from other mechanisms associated with the surgery (n = 8), and stroke unrelated to the reconstructed artery (n = 8). Dividing the operative experience approximately into thirds, during the years 1965 to 1979, 1980 to 1985, and 1986 to 1991 the perioperative stroke rates were 2.7%, 2.2%, and 1.5%, respectively. This, in part, is associated with a better selection of patients (more symptom free, fewer with neurologic deficits). There has been a notable decrease in perioperative stroke caused by ischemia during clamping and intracerebral hemorrhage, but postoperative thrombosis and embolism remain the major cause of neurologic complications. Although patient selection seems to play a role, most perioperative strokes were due to technical errors made during carotid endarterectomy or reconstruction and were preventable.
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              Eagle syndrome as a cause of transient ischemic attacks.

              Mohamed Elhammady, R Heros, Ali A Sultan … (2008)
              Eagle syndrome is an uncommon entity but is well known in the otorhinolaryngology and oral surgery literature. This syndrome results from the compression of cranial nerves in the neck by an elongated styloid process causing unilateral cervical and facial pain. The styloid process can also cause compression of the cervical carotid arteries leading to the so-called carotid artery syndrome together with carotidynia or neurological symptoms due to flow reduction in these arteries. The authors discuss the case of a 70-year-old man who suffered from transient ischemic attacks on turning his head to the left, with immediate remission of symptoms when his head returned to the neutral position. The patient was studied with dynamic angiography, which clearly showed focal flow restriction. Once a diagnosis was made, the styloid process was removed surgically and the patient completely recovered from his symptoms. A postoperative angiogram demonstrated complete resolution of the pathology. Neurosurgeons might encounter patients with Eagle syndrome and should be aware of the symptoms and signs. Once the diagnosis is made, the treatment is clear and very effective.
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                Author and article information

                Contributors
                Tomoya Suzuki
                Toshikazu Kimura
                Hirotaka Hasegawa
                Koreaki Irie
                Sukwoo Hong
                Kostadin Karagiozov
                Shunsuke Ichi
                Journal
                Journal ID (nlm-ta): Surg Neurol Int
                Journal ID (iso-abbrev): Surg Neurol Int
                Title: Surgical Neurology International
                Publisher: Scientific Scholar (USA )
                ISSN (Print): 2229-5097
                ISSN (Electronic): 2152-7806
                Publication date Collection: 2022
                Publication date (Electronic): 25 March 2022
                Volume: 13
                Electronic Location Identifier: 101
                Affiliations
                [1 ]Department of Neurosurgery, The Jikei University Hospital, Minato-ku, Tokyo,
                [2 ]Department of Neurosurgery, Japanese Red Cross Medical Center, Shibuya-ku,
                [3 ]Department of Neurosurgery, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Japan.
                Author notes
                [* ] Corresponding author: Tomoya Suzuki, Department of Neurosurgery, The Jikei University Hospital, Nishishimbashi, Minato-ku, Tokyo, Japan. meatballnikudanngo@ 123456gmail.com
                Article
                Publisher ID: 10.25259/SNI_185_2022
                DOI: 10.25259/SNI_185_2022
                PMC ID: 8986758
                SO-VID: 211a7d86-ac33-4e24-9bb0-815adddade07
                Copyright © Copyright: © 2022 Surgical Neurology International
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 17 February 2022
                Date accepted : 02 March 2022
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: carotid artery dissection,carotid endarterectomy,eagle’s syndrome,elongated styloid process
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: carotid artery dissection, carotid endarterectomy, eagle’s syndrome, elongated styloid process

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