Internal carotid artery anterior transposition for internal jugular vein decompression: illustrative case.

backgroundCompression of the upper segment (J3) of the internal jugular vein (IJV) between the C1 transverse process (C1TP) and styloid process (SP) is an increasingly recognized condition. No previous case of J3-IJV compression by the internal carotid artery (ICA) has been reported. The authors present the case of a patient with J3-IJV compression treated with arterial transposition. OBSERVATIONS: A 49-year-old male presented with a multiyear history of intractable pulsatile tinnitus, headaches, visual disturbances, cognitive disturbance, and head pressure. The patient had previously undergone right transverse sinus stent placement for presumed stenosis, which failed to relieve symptoms. Imaging revealed compression of the right J3-IJV by the adjacent ICA at the level of the SP and atlas. The authors performed anterior transposition of the ICA with fixation to the SP and C1TP resection for circumferential IJV decompression. Complete resolution of all presenting symptoms occurred postoperatively, with sustained improvement at follow-up. Postoperative imaging confirmed elimination of J3-IJV stenosis and disappearance of the posterior collateral network. LESSONS: This case demonstrates that anterior ICA transposition with styloid fixation is a viable surgical option for symptomatic IJV compression. This technique may represent a novel approach for select patients with arterial-venous compression syndromes in the neck. https://thejns.org/doi/10.3171/CASE26599.