Compression of the two IJV and unsuccessful surgery in Russia

Good afternoon, friends!

My name is Egor, I am from Russia, I am 38 years old. For many years, I have been suffering from serious health problems, which, as I already believe, are related to compression of the two internal jugular veins.

My symptoms include :

• A constant feeling of “fog” in the head and lethargy, it is difficult to study, generally mental stres s.

• Poor memory, absent - mindednes s .

• Constant noise / ringing in the ears, chronic nasal congestion, a feeling of bursting of the head – pressure in the head (intracranial pressure ), lack of air, foggy head. These symptoms worsen with little physical exertion, or heat of +28 degrees Celsius and above. Also, during physical exertion, spots appear in front of the eyes (photopsia) – cloudy spots or yellow (when feeling worse), rarely darkens in the eyes to the beat of the heartbeat, lips, cheeks and hands become numb (hands are more likely to be associated with TOS). In the heat, vision sometimes disappears by 40-60% (I just can’t see part of the area). With mental or emotional stress, hyperventilation and lack of air also app ear.

• “Flies” or “midges” in front of the eyes.

• Rarely mild dizz iness.

• Poor sleep, I can’t sleep on the couch-bad sleep lying on your back (I feel sick), I wake up at night every 1.5- 3 hours from lack of air and feeling unwell and severe ringing in my ears.I sleep only on my side, alternately changing sides every hour (it’s easier to sleep on an orthopedic pillow on my side higher so that my head and neck are evenly posit ioned).

• Frequent attacks of suffocation, especially with minor physical e xertion.

I practically don’t drink alcohol, it makes my intracranial pressure rise badly after a couple of hours, and the next day it’s very bad, even from 0.7-1 liters of beer.

• Dysphagia-problems with swallowing food, which often gets a little into the bronchi. Bronchospasms often appear -it is difficult to breathe .

• I can’t talk for long, more than 25-30 minutes, and I almost always breathe throug h my mouth.

• There is also a Kimmerli Anomaly (ponticul us posticus)

• The stair muscles are enlarged , the distance between the anterior stair muscle and the long neck muscle is only 5 mm.

I do not have an overt styloid process, I have a thick digastric muscle, the stylo-hyoid muscle is calcified by segments, abnormal hyoid bone, Ki mmerli and TOS

These symptoms began in adolescence, around the age of 13-14. At the same time, I experienced tachycardia, bradycardia, severe dizziness and headaches (on the left) and nausea, and my blood pressure was unstable. By the age of 17-18, the condition had stabilized, but drowsiness and lethargy appeared. Tinnitus appeared at the age of about 15 years and gradually progressed. By the age of 20-21, physical activity began to be very difficult. The most pronounced deterioration began after the age of 30.

Unfortunately, doctors in Russia do not recognize problems related to veins as the cause of such symptoms. I’ve been seeing doctors since I was 14, but to no avail.

I will upload the pictures and photos later, when the restr iction is lifted.

Now I’m thinking of going to Turkey, to Dr. Kamran Agayev, to have the surgery redone or done on the left side.

At the age of 34, I began to independently study medical literature, human anatomy, and read CT and MRI scans, and I think I found a possible cause of my suffering. Five CT scans showed that there was a problem in the images, but it proved extremely difficult to convin ce doctors of this.

With great difficulty, I managed to persuade a neurosurgeon in Russia (V. A. Lukyanchikov, from the N.V. Sklifosovsky Research Institute of Emergency Medicine, or the Scientific Center of Neurology, Moscow) to perform the operation. On July 9, 2025, decompression of the transverse process C1, partial resection of the transverse process on the right, and the shaving method (high-speed diamond-coated drill) were performed. The surgeon removed about 5 mm of the transverse process, without affecting the muscles (biconvex and stylo-lingual) that en circle this process.

After the surgery, I felt a significant improvement (about 70%), but only for 2-3 weeks. However, as the wound healed and the tissues thickened, the symptom s gradually returned.

I went to the same neurosurgeon again, but he refused to perform a second operation, as he does not believe in veins. Unfortunately, I have not found other specialists in Russia who are ready to perform such an intervention.

The postoperative MRI shows an artifact, which I assume is caused by diamond chips from the drill remaining in the area of surgery. Decompression of the right internal jugular vein, judging by the MRI, did not occur: in the area of the transverse process, the vein looks gray, and only at the confluence of the facial vein it turns black, which, as I understand it, indicates t he speed of blood flow.

ALSO in 2012 (although my head doesn’t turn normally) for 2-3 hours a day for a month, I slept on a hard couch face down, relaxing my neck and spine, placing a thin pillow under my chest and arms, one under my forehead, the other under my mouth to breathe (I almost always breathe through my mouth). A month has passed and I have received a 100% positive effect. I was a completely different person, I breathed normally through my nose, I was cheerful and energetic, there was practically no ringing in my ears. I stopped sleeping face down and after 5 days all the symptoms came back. A short and slow run of 1200-1600 meters, 2 times a week, also helps. My head brightens a little after running, but running itself is hard to bear, espe cially at the beginning.

In addition, I would like to ask the forum administrators to create a separate forum thread so that people who have already had surgery can talk about their current state of health after half a year or a year. That is, they briefly describe what symptoms they had, and which symptoms went away after half a year or a year, or all went away. the symptoms. Who did they have surgery for, what was done to them during the surgery (removal of the styloid, resection of the digastric muscle, and so on). For example, I only got the effect for 2-3 weeks.

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@Filya If you haven’t consulted with Dr. Aghayev yet, I would. Be sure to mention both the ponticulus posticus and your TOS symptoms in the consult request, as he is also very experienced with TOS. I ran your 3D image through AI, and while it would not explain everything, some of your symptoms could very well relate to the ponticulus posticus. He was the first surgeon to identify mine and offered clear next steps.

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Hi & welcome! I’m sorry that your symptoms resolved after surgery, but then returned- it sounds as if your veins successful decompressed, but then perhaps collapsed? I was told after my surgery that sometimes the veins can’t stay open if they’ve been compressed for a while and that stenting may be needed (if all bony compressions are removed), has this been mentioned by your doctor at all?
If I understand right, did you have both sides shaved? Are you thinking that not enough has been removed? It does look like your hyoid bone processes are elongated/ stylo-hyoid ligaments are calcified too, and they look pretty spikey so not surprising if they’re contributing to symptoms! Some of your symptoms could be caused by that, like your voice issues, swallowing …
I had bilateral IJV compression so can sympathise with many of your symptoms- I had to sleep propped up which helped. Are you still sleeping on your front? It sounds as if your vagus nerve could be being irritated, and like you’ve mentioned the carotid artery sinus area which can cause heart arrythmias, BP spikes …
Dr Aghayev in Turkey is very experienced and has done quite a few surgeries for members so he would be a good bet for a consultation… I don’t know if he would address the hyoid bone though, if you do need that trimming too. In addition, your thyroid cartilage looks pretty
There are tips for helping with IJV compression in this section, there might be some ideas of things which could help you in the mean time:
ES Information- Treatment: Pain Relief, Medications and Alternative Therapies - Welcome / Newbies Guide to Eagle Syndrome - Living with Eagle
Not all our members stay on here after surgery; if surgery is successful often people get on with their lives and don’t come back. People who do still have issues often stay on for support still, so if we did a thread for 1 year post-op stories it probably wouldn’t accurately reflect surgical results, would more likely be skewed towards some who still have problems and could potentially put people off having surgery, that would be my worry. Also we’re seeing more & more members with complicated medical conditions, so they may well need more than just ES surgery to improve their health…

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All these syndromes and abnormalities are highly controversial. There is no accurate diagnosis. I have seen numerous CT/MRI scans showing compression of the two internal jugular veins, but the collateral veins are well-developed. However, these individuals do not exhibit any symptoms. Additionally, the IJV is often ligated, tied, or sutured. The TOS often has no significant impact. It is challenging to understand, and no doctor can definitively determine the cause of the symptoms. I am also perplexed.

I had surgery on my right side. I didn’t have surgery on my left side. We still need feedback from people who have had surgery a year later.

Neurosurgeon Lukyanchikov V.A. from the Scientific Center of Neurosciences and Neurology in Moscow does not believe in internal jugular veins and refused to perform another surgical operation. Although he performs surgeries on the Kimmerley anomaly (ponticulus posticus).In Russia, many surgeons remove the styloid processes, but no one touches C1, and they often do not remove the stylohyoid and digastric muscle. Therefore, very often people do not get a positive effect (60-70% of failures), and sometimes they get a deterioration. The same surgeon Nazaryan and others that you have indicated on the your web site/forum do not touch C1 and do not go deep into the problem (they also often have failures). I persuaded neurosurgeon Lukyanchikov V.A. with great difficulty, but he does not believe in it anymore.

V. LUKYANCHIKOV | Professor (Assistant) | Doctor of Philosophy | Research Institute of Emergency Care, Moscow | Department of Neurosurgery | Research profile

Minimally invasive surgical treatment for Kimmerle anomaly - PMC

(PDF) The frequency of vertebral artery sulcus ossification, grades III and IV, in patients with Kimmerle’s anomaly: A systematic review and meta-analysis

Unfortunately alot of doctors are skeptical about vascular ES, so it’s nothing peculiar to Russia… many of our European members have to see Mr Axon in the UK or Dr Aghayev in Turkey as there’s nobody else doing styloidectomy & C1 shaves, and Canadian members are travelling to the US as nobody does this in Canada either … so frustrating as there’s so many research papers about it!
Hopefully you can get the left side done, & as @MGORNEAU suggests ask Dr Aghayev about the TOS and the possible ponticulus posticus, see whether he feels this could be an issue. I don’t know much about ponticulus posticus, but from what I’ve read it seems the it’s a bit like ES- many doctors dismissing it as rare and not being likely to cause symptoms…
Re IJV compression and symptoms, we’ve seen quite a variation on here with the amount of compression and symptoms- there seems to be no correlation as some members have significant compression but seem to cope fairly well, while others have not much compression but are highly symptomatic. We do see that if there are well developed collateral veins it can help the body cope to a point, but often people still get to a place where the body no longer manages and intracranial pressure increases, we’ve seen quite a few members who have pain from the collateral veins too…

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Kimmerley (ponticulus posticus) is mostly asymptomatic in 95% of cases. Sometimes it causes symptoms-causing archer’s syndrome when the vertebral artery is damaged or compressed. Turning the head can cause dizziness or symptoms of an ischemic attack, and this happens almost every time the head is turned. The second factor is the compressed C1 nerve, which can cause headaches in the back of the head. However, this requires a narrow opening. I don’t feel dizzy when I turn my head, and the openings have enough space.

TOS rarely affects the blood supply to the brain, but it often compresses the satellite nerve, causing symptoms similar to Horner’s.

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@Filya They cannot really know how many cases are truly asymptomatic because there is not enough research or consistent investigation to make that claim confidently. Radiologists often do not even mention a ponticulus posticus because it is presumed incidental, yet they usually do not know the patient’s symptoms well enough to determine whether it is contributing. It reminds me of how often styloids are ignored and imaging is called normal, only for Eagle syndrome to be identified later.

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I measured the volumetric velocity of blood flow (flow, fluid flow) three times on a Doppler scan from an ultrasound specialist I know. A manual angle correction was performed (I checked it myself, otherwise all measurements are incorrect without correct angle correction). The measurements were carried out with a time interval of 3-6 months. All measurement values were practically the same (identical). What I got:
The vertebral arteries are 40-45 ml/min each (with a standard of about 80 ml/min per vertebral artery). On the common carotid artery 180-230 ml/min (with a standard of about 330-380 ml/min per CCA, with a standard of about 250 ICA). This indirectly indicates that outflow is difficult (when there is compression on both sides, right and left). But you should not accept Doppler scanning as a standard for diagnostic research. I’ll give you an example, but this is a theoretical assumption. According to the physical laws of hydrodynamics, a liquid flows in large proportions where there is less resistance (compression is resistance). When you have almost completely compressed one side, the brachiocephalic left vein, and the collateral veins, the vena thyroidea inferior, are not developed (for example, between the aortic arch and the sternum), and the right side is open, most of the blood will flow along the right side. And on a Doppler scan of the blood flow in the arteries, everything will be normal (except for a slight decrease in the flow along the left vertebral artery, and it will most likely be hypoplasticized, slightly thinner). What happens in this case (once again, this is an assumption, a theory):
Blood flow (blood flow) most of it flows on the right side, while “stagnation” appears - a low blood flow rate in the area of the cerebellum on the left. Therefore, dizziness may occur in this case . And having performed a surgical operation in the C1 area, you will get almost no effect, and you need to solve the problem in the area of the upper exit of the thoracic aperture (expand the aperture, or do an anamastosis).

Radiopaedia.org

Often, people with compression of the internal jugular veins (IJV), but having well-developed collateral veins, emissary veins, do not have any symptoms. The example in the photo is of developed collateral veins, unlike my undeveloped collateral veins. But also the collateral veins, the vertebral plexus of veins - the emissary veins can be squeezed / clamped by the neck muscles (Musculus obliquus capitis superior, Musculus rectus capitis posterior major neck muscles, between the anterior scalene muscle and Musculus longus colli). Therefore, often working with posture or massaging the neck muscles gives a partial positive effect, the muscles relax, and the veins expand (free space appears, the muscles are not tense). Perhaps that’s why when I slept face down and relaxed my neck, I got a temporary 100% effect. The collateral veins in the neck must have expanded and started working.

And perhaps by performing a TOS surgery, the vertebral veins are released and they expand and begin to work. Therefore, some patients may receive relief and a positive effect.

Comparison of collateral veins in the photo. An example in the photo of developed collateral veins

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I do not deny that ponticulus posticus (which is associated with archer’s syndrome) can cause symptoms in some cases. However, these symptoms are monotonous and easily detectable. Headaches from the back of the head, dizziness, or a transient ischemic attack when turning the head . There is also information that relapses are common and that a bone bridge forms again after half a year. But alas, we have to study everything and figure out our problems thoroughly)))

I also forgot to tell you about the coffee. I didn’t drink coffee before because I was feeling sick. My intracranial pressure was rising, my nose was getting stuffy, my head was getting foggy, and I was running out of air. But I’ve been drinking coffee for the last 4 years, and I feel sick for 40 minutes, but I’m used to it.

I will probably go to Dr. Kamran Agayev in Turkey, but the cost of a surgical operation on one side, one place, is 10 thousand dollars. Therefore, I can only count on one place, and I can’t afford the other option, or two sides (I don’t have any more money).

It is a pity that surgeons in Russia do not believe in veins and the vagus nerve, and they do not want to develop and learn something new. Because of this, many people in Russia get sick and no one helps them, they have to travel to another country.

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@Filya Some of your symptoms do overlap with those reported in the ponticulus posticus literature, particularly the head pressure/headache, tinnitus or hearing-related symptoms, visual disturbances, swallowing issues, and strong positional component. That does not prove it is the cause, especially with your jugular compression and TOS, but I would not dismiss it solely because you do not experience classic dizziness every time you turn your head.

Sources: Research Progress of Ponticulus Posticus: A Narrative Literature Review, Research Progress of Ponticulus Posticus: A Narrative Literature Review - PMC and Prevalence of Ponticulus Posticus and Migraine in 220 Orthodontic Patients,https://www.mdpi.com/2079-7737/12/3/471.

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Thanks for this article @MGORNEAU , I’ve re-posted this in the Research Papers category…

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Do not believe unconditionally everything that is written in medical articles. Many medical articles have the wrong path - experimental medicine. Many articles are written by interns. Doctors are people too, they make mistakes too . That’s why many doctors don’t believe in it. Neurosurgeon Lukyanchikov performed about 100 surgical operations on kimmerle (ponticulus posticulus). And he performed a surgical operation on me. If he doesn’t see a problem in Kimmerle, then it’s not there. I hardly ever get headaches or dizziness anymore, but I did until I was 17.