PMC10277496_01
Axial CT scans through the C1 vertebra following intravenous contrast (A) before surgery show the jugular vein on the right side (thin arrow) markedly narrowed between the styloid process (horizontal thick arrow) and the C1 transverse process (asterisk) and on the left side compressed into invisibility between the styloid process (vertical thick arrow) and the C1 transverse process (asterisk). (B) After resection of the left styloid and C1 transverse process (resection margin, black arrows), the left jugular vein (thin arrow), though still narrowed, is now visible. The right jugular vein is unchanged, as expected.
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fig1
This showed normal intracranial venous sinuses but marked narrowing of both jugular veins between the styloid processes of the skull and the transverse processes of the C1 vertebra (Figure 1A).
(A) Lateral view of the left jugular venogram showing marked narrowing of the jugular vein (arrow) between the (unseen) C1 transverse process and the (unseen) styloid. Intravascular contrast is dark, outlining the jugular vein above and below. (B) Same view with the angioplasty balloon (arrowheads) inflated across the site of narrowing.
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fig2
H2O gradient (Figure 2A). He had bilateral jugular venoplasty (Figure 2B) with no immediate effect, but over the following week, his physical and vocal tics were greatly reduced.