Eagle Syndrome and Internal Carotid Artery Dissection: Description of 5 Cases Treated in 2 Vascular Institutions and Review of the Literature

Eagle syndrome is a rare pattern of symptoms (0.16% of general population) due to the conflict with adjacent anatomical structures by an elongated styloid process or a calcified stylohyoid ligament; two variants of this condition have been described in the literature, classical and vascular. The classical form is caused by compression of the glossopharyngeal nerve and the surrounding structures from an abnormal stylohyoid apparatus, causing odynophagia and neck pain and is usually treated by otorhinolaryngologist. The vascular form, determined by the conflict between the osteo-ligamentous malformation and the extracranial carotid artery, can cause neurological symptoms due to the compression of the vessel or in some cases the dissection of the carotid artery itself. However an elongated styloid process occurs in about 4% of general population, and the most recent literature shows that the vascular form of Eagle syndrome could be an underestimated cause of carotid artery dissection (CAD) and should be considered in the differential diagnosis of this condition. In addition in the literature many different treatment options for this condition are reported, either medical and/or surgical, but an ideal approach has not yet been fully identified. We report 5 cases of internal CAD due to the vascular variant of Eagle syndrome treated in two different Italian institutions (Department of Vascular and Endovascular Surgery, Galliera Hospital, Genoa and Department of Vascular Surgery, Santi Filippo e Nicola Hospital, Avezzano, L'Aquila) and a careful and analytical review of the available literature on this topic.