Quality of Life Outcomes Following Styloidectomy/C1 Ostectomy in Patients with Extracranial Venous Outflow Obstruction

Introduction: Idiopathic intracranial hypertension (IIH) is characterized by inexpicably elevated intracranial pressure. Hallmark symptoms include headache, pulsatile tinnitus, transient visual obscurations, and papilledema. While traditional treatments include weight loss, acetazolamide, CSF diversion, and venous sinus stenting, focus is shifting toward addressing extracranial venous outflow obstruction. As the internal jugular veins (IJVs) are commonly affected, surgical resection of impinging structures, such as the styloid process and C1 transverse process, is becoming more popular. This study is among the first to report on objective patient-centered outcomes after styloidectomy/C1 ostectomy. Methods: A retrospective chart review was performed at a single site. Patients were included if they underwent unilateral styloidectomy/C1 ostectomy and completed the following standardized instruments immediately post-operatively and 3 months post-operatively: Cerebral Venous Disease Symptom Score (CVDSS), Headache Impact Test (HIT-6), 12-item Short Form Survey (SF-12), and Quick Dementia Rating System (QDRS). Descriptive statistics and non-parametric tests were used to summarize data. Visual evaluation of pre- and post-operative computed tomography venogram (CTV) was performed to determine whether IJV patency improved postoperatively. Results: 13 patients (92.3% F) met inclusion criteria. Median age was 46 (33, 55) years, BMI was 25.5 (21.6, 29.4) kg/m2, and duration of IIH symptomatology was 9 (5.5, 12) years. Median pre-operative CVDSS score was 15 (14, 19), which improved to 8 (3, 13) post-operatively (Wilcoxon p = 0.007) while HIT-6 scores improved from 32 (24, 35) to 19 (7, 26) (Wilcoxon p = 0.04, Cohen's d=1.2) ([ Fig. 1 ]). Median SF-12 Mental Component Score (MCS) increased from 26.9 (20.6, 29.4) to 36.5 (30.0, 46.9) (Wilcoxon p = 0.01, Cohen's d=-1.3), and Physical Component Score (PCS) increased from 26.8 (24.0, 30.2) to 35.3 (32.3, 43.0) (Wilcoxon p = 0.01, Cohen's d=-1.2) ( Fig. 2 ). Median cognitive QDRS subscore decreased from 2.5 (0.6, 3.5) to 0.3 (0, 2.5) (Wilcoxon p = 0.1, Cohen's d=0.7), behavioral QDRS subscore decreased from 5.8 (4.0, 6.9) to 0.8 (0.5, 4.4) ( p = 0.03, Cohen's d=1.0), and total QDRS score decreased from 8.8 (4.4, 10.4) to 2.3 (0.6, 5.0) (Wilcoxon p = 0.02, Cohen's d=1.0) ( Fig. 3 ). All patients demonstrated a visible improvement in IJV patency on CTV postoperatively ([ Fig. 4 ]). Fig. 1 Change in CVDSS and HIT-6 scores after styloidectomy/C1 ostectomy. Fig. 2 Change in SF-12 mental (MCS-12) and physical (PSC-12) scores after styloidectomy/C1 ostectomy. Fig. 3 Change in QDRS cognitive, behavioral, and total scores after styloidectomy/C1 ostectomy. Fig. 4 Axial CTVs of a characteristic C1 ostectomy/styloidectomy patient immediately pre- and post-operatively. ( A ) Pre-operative CTV showing right IJV compressed between styloid process (red arrow) and C1 transverse process (black arrows). ( B ) Post-operative CTV showing patent right IJV (blue arrow) without osteological compressions due to resected styloid and C1 transverse process (black arrow). Conclusion: Given the strong observed effect sizes, styloidectomy/C1 ostectomy may be associated with significant, multi-domain quality of life improvement with respect to headaches, physical and mental well-being, cognition, and behavior in those afflicted with IIH due to extracranial venous outflow obstruction. These findings support further exploration of this surgical intervention, ideally in larger prospective studies. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany