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We report a 3-year-old boy with macrocephaly, papilledema, and headaches associated with bilateral hypoplastic jugular bulbs leading to intracranial hypertension. Initial imaging was misinterpreted as idiopathic intracranial hypertension, and medical therapy with acetazolamide failed. Repeat MRI/MRV demonstrated thrombosis of the right transverse sinus with orbital collateral drainage. Angiography confirmed occlusion of the right jugular bulb and severe stenosis of the left. Due to progressive symptoms and developmental risk, rescue endovascular stenting of the right internal jugular vein was performed using a transvenous approach with angioplasty and deployment of a 7×30 mm stent. The procedure restored venous outflow and relieved congestion without complications. Intracranial pressure normalized, papilledema resolved, and neurocognitive improvement was observed at 6 months. At 9-month follow-up, MRI/MRV demonstrated occlusion of the right internal jugular vein stent. Despite this finding, follow-up ophthalmologic evaluation showed sustained improvement in papilledema. The patient remained clinically stable without recurrence of headaches or ocular congestion. This first-reported case of congenital bilateral jugular bulb hypoplasia treated with venous stenting highlights the importance of recognizing venous outflow anomalies as potential causes of pediatric intracranial hypertension.

Purpose The use of real-time ultrasound (US) has been shown to reduce complications of central venous (CV) catheterization. However, complication rates have not been compared according to insertion points for CV catheterization using US. Accordingly, this study aimed to compare the complication rates of internal jugular vein (IJV) with those of subclavian vein (SCV) catheterization. Methods Three tertiary academic hospitals in South Korea participated in this multicenter, randomized study. A total of 1484 patients were preoperatively randomized into two groups. The IJV group ( n  = 742) was cannulated via the right IJV, and the SCV group ( n  = 742) was cannulated via the right SCV under US guidance. The primary outcome measure was total complication rate. Secondary outcomes included access time for the first attempt, number of attempts, and catheter position. Results The total complication rate did not demonstrate a significant difference between the IJV (0.1%) and SCV (0.7%) groups ( P  = 0.248). In the IJV group, arterial puncture occurred in 0.1% of patients; in the SCV group, arterial puncture occurred in 0.6% and pneumothorax in 0.1%. The success rate on the first attempt was significantly higher in the IJV group (98.4%) than in the SCV group (95.9%) ( P  = 0.004). The access time for the first attempt ( P  < 0.001) and the median number of attempts ( P  = 0.006) were significantly lower in the IJV group than in the SCV group. More catheter misplacements were observed in the SCV group (5.9%) than in the IJV group (0.4%) ( P  < 0.001). Conclusion Results demonstrated that the complication rates of IJV and SCV catheterizations using US are very low, showing no superiority of the SCV approach compared to the IJV.

The use of ultrasound (US) has been proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement. In this review, we describe the rationale for the use of US during CVC placement, the basic principles of this technique, and the current evidence and existing guidelines for its use. In addition, we recommend a structured approach for US-guided central venous access for clinical practice. Static and real-time US can be used to visualize the anatomy and patency of the target vein in a short-axis and a long-axis view. US-guided needle advancement can be performed in an \"out-of-plane\" and an \"in-plane\" technique. There is clear evidence that US offers gains in safety and quality during CVC placement in the internal jugular vein. For the subclavian and femoral veins, US offers small gains in safety and quality. Based on the available evidence from clinical studies, several guidelines from medical societies strongly recommend the use of US for CVC placement in the internal jugular vein. Data from survey studies show that there is still a gap between the existing evidence and guidelines and the use of US in clinical practice. For clinical practice, we recommend a six-step systematic approach for US-guided central venous access that includes assessing the target vein (anatomy and vessel localization, vessel patency), using real-time US guidance for puncture of the vein, and confirming the correct needle, wire, and catheter position in the vein. To achieve the best skill level for CVC placement the knowledge from anatomic landmark techniques and the knowledge from US-guided CVC placement need to be combined and integrated.

Purpose The superficial middle cerebral vein (SMCV) typically drains into the cavernous sinus, which, in turn, connects to the pterygoid venous plexus via a sphenoidal emissary vein. The latter may course through the foramen ovale. The pterygoid plexus drains in most cases into the retromandibular and facial veins. A peculiar SMCV drainage pathway to the internal jugular vein (IJV) via a parapharyngeal vein was found here. Method The anatomic variant reported here was identified by carefully reviewing the archived CT angiogram in a 68-year-old male case. Results A double SMCV was found on the right side. The resulting common SMCV trunk passed laterally to the foramen rotundum to empty into the cavernous sinus. A sphenoidal emissary vein joined it, which continued inferiorly through the foramen ovale to the pterygoid plexus. This plexus was connected to a reservoir on the inner side of the lateral pterygoid plate from which a fenestrated parapharyngeal vein left. It had two primary fenestrations, and the proximal one had a fenestrated arm. It reached inferiorly and turned around the external carotid artery. At that level, it received two tributaries: first, the superior thyroid vein and then, the facial vein. The resulting facial-parapharyngeal trunk ended in the IJV. These veins and the carotid arteries, deep to them, were hidden beneath the submandibular gland. The right maxillary vein and the anterior branch of the retromandibular vein were absent. Conclusion The parapharyngeal vein may be a direct drainage pathway for the SMCV and the pterygoid plexus. It should therefore be acknowledged and spared during various surgical approaches.

Modified combined short and long axis method (MCSL) can replace oblique axis in-plane method (OA-IP) for internal jugular vein cannulation (IJVC). This randomized, non-inferiority study estimated the efficacy of MCSL compared with OA-IP in right IJVC. Patients (18-75 yr. old) undergoing right IJVC under local anesthesia were randomly assigned to MCSL or OA-IP group. The primary outcome is the event of first needle pass without posterior vessel wall puncture (PVWP). Secondary outcomes included needle attempts, success rate, puncture and cannulation time, needle visualization, probe placement difficulty and complications. Among 190 randomized patients, 187 were involved in the analysis. The first needle pass without PVWP was 85(89.47%) in the MCSL and 81 (85.26%) in the OA-IP (p = 0.382), with a mean rate difference of 4.2% (95% confidence interval: -5.2-13.6), which confirmed the non-inferiority with the margin of -8%. MCSL group exhibited shorter procedure time and lower complications than OA-IP group. No significant differences were discovered between groups in needle attempts, success rate, incidence of probe placement difficulty and needle visualization. MCSL is non-inferior to OA-IP in first needle pass without PVWP in adults who underwent elective right IJVC and associate with less complications and shorter operating time. ChiCTR, ChiCTR2100046899.

The internal jugular vein (IJV) is of utmost importance during various surgical and endovascular approaches, including central access. It descends through the parapharyngeal space, carotid triangle, and sternocleidomastoid region. The anatomical variables of the IJV are mainly related to its calibre and dominance, number of venous channels (i.e., duplications and fenestrations), and compression sites. Specific compressions of the IJV are not exclusively due to the jugular nutcracker between the styloid process (SP) of the temporal bone and the C1 transverse process, which, in turn, should not be granted the eponym of Eagle. The possible morphologies of the SP and ossified stylohyoid chain are discussed here. Additionally, the digastric and sternocleidomastoid muscles, the hyoid, and the distorted carotid arteries may compress the IJV, thereby raising intracranial pressure. Here, a case is documented with a long inferior petrosal sinus adjacent to the IJV, both compressed into the C1–styloid nutcracker, which is an absolute novelty. Multiple compression sites of the IJV are supported here with original evidence. All anatomical variables of the IJV are relevant, as they may lead to stenoses or interfere with IJV cannulation. In rare cases of IJV agenesis, multiple compression sites on the opposite side may significantly alter bilateral cerebral drainage. Different methods may be used to decompress a stenotic IJV, including styloidectomy. In conclusion, the anatomical variables of the IJV should be acknowledged by practitioners and documented on a case-by-case basis.

Background Centrally Inserted Central Catheter (CICC) placing procedure is challenging in the pediatric population, especially in newborns and infants, leading to lower success and higher complication rates than in adults. The aim of this study was to compare three approaches: open technique, SELDINGER’S technique with surgical isolation of the vein, and percutaneous ultrasound-guided CICC insertion for central line insertion in infancy as regards safety, success of cannulation, technique time, and preservation of the patency of the internal jugular vein (IJV). Methods This prospective randomized cohort study was conducted after approval of the Ethical Committee of Tanta University Hospital with approval code: 36264MS38/1/23 (clinical trial ID: NCT06862492 and date: 03/05/2025). This study adheres to CONSORT guidelines. This study included 105 infants in need of CVC insertion over a period of 6 months. They were randomly allocated into three equal groups; group A underwent CICC insertion using the open surgical technique, group B underwent SELDINGER’S technique with surgical isolation of the vein, and group C underwent percutaneous ultrasound-guided CICC insertion. Results Patency was significantly higher in SELDINGER’S technique with surgical isolation of the vein and percutaneous ultrasound-guided techniques compared to the open surgical technique ( P  = 0.003, < 0.001). There was a significant negative correlation between patency of IJV and duration of CICC placement ( r  = -0.238, P  = 0.010) and with the number of trials to success of the cannulation ( r  = -0.252, P  = 0.006). The technique time was significantly shorter in the percutaneous ultrasound-guided technique compared to open surgical and SELDINGER’S technique with surgical isolation of the vein ( P  < 0.001, < 0.001). SELDINGER’S technique with surgical isolation of the vein was a significantly shorter technique time when compared to the open surgical technique ( P  < 0.001). Conclusions US-guided catheterization of the IJV shows more advantages in the form of a less time-consuming technique with a high first attempt and insertion success rate and fewer trials compared to CICC insertion using either open surgical technique or SELDINGER’S technique with surgical isolation of the vein. Trial registration Current Controlled Trials NCT06862492 and date: 03/05/2025.

The internal jugular vein is one of the major vessels of the neck. The anatomy of this vessel is considered to be relatively stable. It is an important landmark for head and neck surgeons as well as the anaesthetists for both diagnostic and therapeutic purposes. We present two case reports of the posterior tributary of the internal jugular vein and review the surgical literature regarding anatomical variations of the vein. A total of 1197 patients from 27 published papers were included in this review. Of these patients, 99.6% had neck surgery and the rest were cadaveric dissections. Anatomical variations of the internal jugular vein were found in 2% of the patient cohort (n = 40). The majority of these patients had either bifurcation or fenestration of the vein. The posterior tributary of the internal jugular vein is unusual and is scarcely reported in the literature (three cases). Knowledge of variations in the anatomy of the internal jugular vein assists surgeons in avoiding complications during neck surgery and preventing morbidity. Two rare cases of posterior branching of the internal jugular vein and experience of other surgeons are demonstrated in this extensive review.

Aims This study aimed to characterize the clinical features of headache in patients with non‐thrombotic internal jugular vein stenosis (IJVS) and to identify associated risk factors. Methods This retrospective study consecutively enrolled patients with imaging‐confirmed non‐thrombotic IJVS from January 2021 through July 2024. Participants were divided into IJVS‐headache and IJVS‐without‐headache groups based on clinical symptoms. Demographic, clinical, neuroimaging, and treatment data were reviewed in detail. Univariate and multivariate logistic regression analyses were performed to determine risk factors for headache. Results Among 283 eligible patients (median age: 51 years in the IJVS‐headache group vs. 56 years in the IJVS‐without‐headache group, p < 0.001), 65.02% reported headache. Most headaches were chronic (82.07%), generalized (85.87%), and moderate in intensity (53.26%), with notable daily life impact (57.61%). Univariate analysis showed that headache was significantly associated with visual disturbances (p = 0.010), elevated cerebrospinal fluid opening pressure (p < 0.001), high jugular bulb (p = 0.007), and severe scalp vein dilation (p < 0.001), but inversely associated with severe vertebral vein expansion (p < 0.001). Multivariate regression revealed that high jugular bulb (OR = 3.144, 95% CI: 1.083–9.123, p = 0.035), severe scalp vein dilation (OR = 2.142, 95% CI: 1.068–4.294, p = 0.032), and protein C or S deficiency (OR = 5.984, 95% CI: 1.196–29.928, p = 0.029) were independent risk factors, whereas severe vertebral vein expansion was protective (OR = 0.184, 95% CI: 0.092–0.366, p < 0.001). Conclusions Headache represents a prevalent and often disabling symptom in non‐thrombotic IJVS, underpinned by distinctive vascular and hematologic profiles. Identification of high‐risk patients based on neuroimaging and thrombophilia screening may facilitate personalized interventions and improve symptom control. Approximately two‐thirds of non‐thrombotic IJVS patients experienced headache, generally moderate, chronic, and diffuse. Identifying clinical and neuroimaging risk factors of headache may help guide individualized management strategies to reduce headache occurrence.

Background and Objectives: The jugular bulb (JB) is the uppermost part of the internal jugular vein receiving the sigmoid sinus. The aim of the present research is to aid the comprehension of the JB, its abnormalities, and surrounding structures for improving both academic and surgical awareness. Materials and Methods: Various studies on this topic were critically reviewed. Cone-beam CT scans and CT and MR angiograms were used to demonstrate each type of the discussed variations. Results: Variations in the JB anatomy were thoroughly documented: high JB, dehiscent JB, hypoplasia and hyperplasia, and diverticula of the JB, as they have significant clinical implications, particularly in the context of otological and neuro-otological surgery, skull base pathology, and diagnostic imaging. Definitions and critical arguments were also specified to clarify existing literature. Additionally, we present a case report illustrating a high and dehiscent JB, an anatomical variation of clinical interest due to its potential for misdiagnosis as a glomus tumor. Another case describes a dehiscent JB with a hypotympanic air cell protruding into it, further highlighting the variability of this condition. Conclusions: It is necessary to proceed with caution when observing abnormal morphological characteristics of the JB. Preoperative assessment of each case is essential for optimal outcomes.