It is all about the amount of blood that they drain which is proportional to their sizes. Your right IJV is dominant because it is bigger in diameter and as result drains more than the left IJV does. So if we assume (not scientific but to make the point) that your right drains 65% - 70% of your brain fluid (CSF + blood) and your left IJV drains 30% - 35%, then it is clear which pipe (IJV) you want to open up for optimal drainage to occur. It is also true in most cases, that the smaller IJV connects to smaller Sigmoid-Transverse Sinus once it enters the skull (Red arrow points where it enters the skull and joins to the Sigmoid Sinus). So the net-flow from the brain to the left IJV is minimal and that the narrowing is not confined to the IJV and compression area only but it is an overall narrowing by birth in most of the cases. So in your case, you will benefit more by opening up your dominant IJV first compared to opening the smaller left IJV ( You can do this after the dominant one). So in short, to get the most out of your first surgery, I would proceed with right IJV decompression (C1 atlas shaving & Styloid removal). This should, hopefully, resolve most of your symptoms except the left sided ones which I think are caused by that elongated styloid on the left but not outflow restriction since the amount it drains is relatively smaller compared to the right IJV.
Yes, you got it. I am not a doctor but based on all the research I read, your left IJV appears to have longitudinal luminal defect (meaning vertical narrowing - Area is pointed by Cyan Bars) and even if the compression was removed, that segment appears to be fibrotic (Read somewhere that due to a lengthy compression, veins lose their elasticity & become fibrotic) and could potentially need further intervention such as stenting.
I also noticed that your dominant right IJV has somewhat milder compression from sternocleidomastoid muscle (SCM) near the base of the neck ( Second image - Cyan Arrow - > SCM & Blue Arrow → right IJV). This one is minimal compared to the C1 & Styloid compression on it.
As far as your symptoms are concerned, I would say I have 90% of them. The only difference is your left sided ones because I do not have that elongated Styloid on your left side which could potential be messing with nerves such as Vagus nerve among other ones causing neck pain and dysautonomia (shortness of breath).
For mitigation, I might add to your list the following which I find helpful
- MAGNESIUM L-THREONATE is special magnesium which helps with sleep and cognitive function (Research based benefits - crosses brain-blood barrier and enhances cognitive function and sleep)
- Soft Collar Neck Brace to help keep your neck straight.
- Stay away from high doses of Vitaman A (only if you take Multi-Vitamins). It is linked to aid rapid CSF production and since our drainage is impaired, it adds to the load in the brain.
I did talk about what help me here (I'm back - surgery with Dr Axon - #24 by KoolDude)
