Hello, I wanted to know if Dr. Aghayev cuts as much styloid as Osborne, that is, right at the base of the styloid? Thank you.
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We’ve been told he cuts it above C1 which is skull base or very close to it.
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Hello, I have the impression that Osborne goes even higher, doesn’t he? Because he cuts in front of the ear? Thank you
I don’t believe that Dr Osborne goes higher , but worth checking with him. And it’s also worth noting that none of the doctors will go right to the skull base if the nerves are too close, so it can’t be guaranteed.
What if the facial nerve is compressed? Is there no solution for you? Thanks 
@Jordan -
In our experience, the facial nerve is not usually compressed right at the skull base. It gets compressed further down by the styloid or calcified stylohyoid ligament. However, that’s not to say compression never occurs up close to the skull base.
Do you know for a fact you have facial nerve compression close to your skull base? What symptoms do you have that you think are being caused by your facial nerve?
The facial nerve is very delicate & easily damaged - it’s one of the nerves most commonly affected during surgery, but heals with time…so given that it’s usually in the way with surgeries, whatever the method, I would think that it’s equally likely that any compression on it will be removed during surgery, as long as the styloid is reasonably shortened, and not necessarily because of the method- does that make sense?
The trigeminal nerve is also commonly affected , this has a similar pathway to the facial nerve, & usually surgery resolves the compression on this nerve.
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Thank you for your replies However, I have had 3 operations with ENT specialists who all said they could not cut the styloid process further because the facial nerve was too close. I wonder if Dr. Aghayev could do better 
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@Jordan - I’m sorry you’ve already been through 3 styloidectomies. Do you know how short your styloid is? Even the most experienced doctors usually leave a .05 cm- 1cm stub. You could certainly set up an appointment w/ Dr. Aghayev to discuss your situation & see what he thinks. He will need a current CT scan so he can see the length your styloid is at this point in time.
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Ah, sorry I’d forgotten that; it may be that a more experienced surgeon could avoid the facial nerve, but a good question to ask Dr Aghayev…
Hello I had an appointment with him and he said that the remaining styloid process needs to be cut and C1 shaved, but I’m scared because I have no blood symptoms, it’s neurological, and I can no longer swallow my own saliva. I’m scared today after so many failures.
@Jordan - It’s always OK to question a surgeon’s suggestions regarding what should be done in a surgery. Did you happen to ask why he thought C1 needs to be shaved? It could be that it’s infringing on the carotid sheath where the ICA, IJV & vagus & other nerves live in tandem. If that’s the case then the vagus nerve may be experiencing some compression. As it plays a significant role in swallowing, it could be the reason you’re having trouble there. The vagus nerve, trigeminal nerve & glossopharyngeal nerve are the key players in swallowing, not the facial nerve.
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@Isaiah_40_31 has made a good point about his plan, but we should always be ready to question doctors and to make our own decisions, it’s your body after all. So I would try and ask why he feels the C1 needs shaving too?
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Hello again. What also scares me is that I had an appointment with Dr. Moises Guerrero, a maxillofacial surgeon, who tells me the problem is my jaw and the mandibular ligament causing all this. Kamran Aghayev, on the other hand, tells me it’s the C1 cervical vertebra and the remaining apophysis. It’s complicated…
I’d say both doctors are correct. Your left IJV is very compressed from your skull base to just below your C1 vertebra. I’ve put a blue oval around it in the image below. You also have collateral veins I didn’t annotate, due to lack of space, which are just to the right of the yellow arrow for the TP of C1. Those veins develop to help with blood flow out of the brain when the IJV(s) isn’t/aren’t working well.
Your styloid is normal length but very thick & is likely contributing to IJV compression at your skull base. If I’ve marked it correctly, your stylomandibular ligament (SML) is also somewhat calcified & pointed so could be contributing to nerve pain symptoms. Ernest Syndrome is the name given to calcified stylomandibular ligaments. We’ve had several members who had both elongated styloids/calcified stylohyoid ligaments, & one or both stylomandibular ligaments were also calcified.
The greater horns of your hyoid bone are quite thick. I’ve put an orange arrow pointing at the area where the right greater horn appears to be possibly touching your carotid on the right side. I’m not sure about that as it may just be the angle of the image that makes it look that way. If there is contact, it can also be contributing to vascular symptoms.
Thank you so much, that’s so kind. My severe pain is excruciating neuropathic pain, and I think I have a problem with my hyoid bone. Thank you for your time, it’s truly lovely, but I’m lost and don’t know what to do anymore. I’ve already had three Eagle surgeries, and I’m afraid that removing the styloid process and ripping C1 won’t be enough. I’m lost. Thank you again.
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If you’re considering seeing Dr. Aghayev, you can always ask him what he sees going on with your hyoid bone @Jordan. At least you would have an answer as to whether it may also be causing problems for you.
We’ve just gotten the name of a doctor in Italy who is familiar w/ IJV compression related to ES. You might be interested in consulting with him? Until your IJV is decompressed, you’ll continue to feel awful so I hope you’re able to settle on someone to do that surgery for you. That is the reason your 3 styloidectomies haven’t given you symptoms relief.
I’m sorry you’re still feeling so bad & hope you’re able to find a path to feeling better soon.. 
•Dr. Raffaello Pagani - Personalized Therapies for CCSVI: Effective Treatment Options or Dr. Raffaello Pagani – Vascular Surgery and CCSVI None of our members have seen this doctor but he does know about vES w/ IJV compression & appears to do surgery for it.
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Thank you from the bottom of my heart.
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@Jordan - I’m glad Dr. Aghayev has answered you regarding the stylomandibular ligament. I think he would be a good surgeon to see as he would also take care of your IJV decompression which will help you A LOT!!
I just re-looked at your hyoid bone, & the greater horns, besides being very thick, look quite close to your spine. This could be in part because you’ve lost the natural lordotic curve in your cervical spine & now have “military neck”. That can be restored with gentle PT exercises, but it takes time & consistency.
Having the greater horns of your hyoid so close to your spine can cause hyoid bone syndrome (HBS) symptoms. It’s possible w/ cervical spine curve correction, the hyoid bone symptoms might slowly disappear without surgery.
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