Bilateral Vs one at a time?

Question on styloid surgery for vascular Eagle’s:

Q: Remove both or do it in two separate procedures?

Hello, I’m seeking opinions and experience on the risks/benefits of bilateral styloidectomy, to decompress internal jugular veins.

My particular worry is that, if your issues come from IJV compression, the swelling from surgery on both sides could temporarily cause both IJV’s to become even more constricted than usual, causing big problems.

Also, I’m interested to know what the surgeons think. I get the impression many prefer to remove one at a time?

Thanks! :blush:

Pretty much the only surgeon we know of doing bilateral surgery routinely is Dr Hackman in NC, most surgeons prefer to do one side at a time because of the swelling. As you say, with vascular compression, that would pose an extra risk, plus as some doctors (Dr Hepworth in CO for example) check that the IJVs are working better after surgery I would guess that it wouldn’t be ideal to balloon both of them in one surgery? Dr Hackman doesn’t do that as far as I know, but if anyone knows different please say!
Personally having one side done at a time was enough for me, I was lucky that it wasn’t too painful, but it’s so hard to get comfy after one side is done let alone both…My surgeon preferred to leave it a few months between surgeries, his words were that ‘it would be too much’ to do both sides at once.
There have been quite a few discussions about bilateral surgery you could search for, & the members who’ve had surgery with Dr Hackman seem very pleased with the results & speak very highly of him.


Thanks Jules, that’s kind of the conclusion I’m coming to having read around some more. One at a time seems safer