WOW @anon30378544! There is a big difference between the two sides. I’m really glad the non-functional side recovered even if it took a couple of months!
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I don’t know why the forum moderators restricted my ability to post links, so I’ll attach screenshots ,it is forbidden to post photos(maybe because I ask a lot of questions? ))) ) I’ve been studying these medical articles for a long time. I’ve also consulted with several maxillofacial surgeons and neurosurgeons. All of them (and this is also mentioned in the medical articles) agree that removing the styloid process is not effective in most cases. Many patients (60-70 out of 100 patients) who had their styloid process removed (even on both sides) did not experience any positive effects. That’s why surgeons in our country don’t really believe in styloid process .In addition, in our country, surgeons don’t believe in veins, and they simply prescribe conservative treatment, which in most cases only provides a partial positive effect. But in our country, they don’t resect C1 and remove the digastric muscle and stylohyoid muscle.
But as we can see in medical articles and on the forum about C1 resection, there are also frequent cases of symptoms returning (due to scar/fibrous muscle tissue, I suppose, but I am not a doctor). It is not yet clear whether partial resection of the rectus digastric and stylohyoid muscles solves this problem. It is also unclear what will happen to the stability of C1 when the muscles attached to C1 are cut. There may also be other areas of compression of the internal jugular veins and brachiocephalic veins that the surgeon may not notice or see. (between the anterior scalene muscle and the sternocleidomastoid muscle, lymph nodes, between the scapula of the sternum and the aortic arch, Omohyoid, thrombosis of the transverse venous sinus. As well as scarring and fibrosis of the muscle tissue after surgery or vein thrombosis).Before surgery, you should study all the CT and MRI scans carefully, try conservative treatment, and then make a decision.
As for the removal of only the styloid process, it is already clear, and there is a lot of practice. The removal of the styloid process helps only when there is facial pain (80-90%) or when there is visible compression of the internal carotid artery. In these cases, the symptoms disappear in 80-90% of patients. As for the compression of the internal jugular veins, the effectiveness statistics are extremely low, and removing only the styloid process will help only a few patients (30-40 out of 100 patients). Therefore, it is up to you and your doctors to decide whether or not to undergo surgery and which type of surgery to choose. It is important to note that no one can guarantee a 100% positive outcome. Additionally, there is a risk of complications.
Med articles:
Effectiveness of Atlas Transverse Process Resection Combined With Release and Perfusion Techniques in Treating Clinical Symptoms Caused by Internal Jugular Vein Stenosis Secondary to External Compression ( doi 10.1016/j.wneu.2025.124397);
Surgical treatment for cognitive impairment caused by internal jugular vein stenosis: a clinical study of atlas transverse process resection (doi: 10.3389/fneur.2026.1776658);
Cerebral Venous Outflow Insufficiency: A Study on Symptoms and Venous Stenosis Classification (doi: 10.1002/mco2.70609);
Case Report: Isolated surgical decompression for compressive internal jugular vein stenosis: case series and literature review (doi: 10.3389/fsurg.2025.1639108)
Case Report: Unveiling segmental hemodynamic heterogeneity in internal jugular vein stenosis: a patient-specific CFD analysis (doi 10.3389/fcvm.2025.1681287)
Styloidectomy for Jugular Decompression in Venous Outflow Disorders (doi 10.1016/j.wneu.2025.124717 Edward J. Hepworth , Kyle M. Fargen )
Sternocleidomastoid Omohyoid Entrapment of the Internal Jugular Vein Causing Vertigo and Headaches (doi: 10.1111/coa.14325)
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Thank you for these papers and sharing your synopsis. I’ve used these studies and my imaging to create an AI generated patient report for my case. I have extensive calcification of both styloids and right sided IJV compression between my styloid and C1. My left side only has intermittent ear pain but my right side has lots of symptoms including noticeable neck swelling that I believe is due to the IJV compression - see my 3D images on my thread "worse than I thought’.
I am now consulting several doctors and trying to decide if my treatment path should include styloidectomy alone or a combination of styloidectomy and C1 resection. One thing I noticed about these papers is that the patient symptoms of their IJV included head noises, auditory/visual disturbances, tinnitus, balance issues, cognitive difficulties etc, but I do not have any of these symptoms. Also I have chronic neck pain, stiffness, and pinched nerve symptoms on the back right side of my neck near C1. For these reasons, I am leaning towards styloidectomy alone. I will update my thread after my consultations with Dr. Osborne and Dr. Liu.
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Your couple of images are not enough. According to those images, you do not have critical compression of the internal jugular vein on the left, and even on the right, it is not completely compressed. You also have good venous collaterals. If you say that you do not have any symptoms (such as foggy head or ringing in the ears), except for pain and muscle spasms in your neck, it confirms that your venous drainage is normal. Your C1 transverse processes are small, and it is unlikely that you will need to have them removed. But I’m not a doctor, and it’s up to you))) There is only a risk in the digastric muscle and scar tissue, when the styloid process is removed, the digastric muscle may press against the transverse process C1, in addition to scar tissue. You can try to remove only the stylohoid process on one side. Did you exercise intensively in childhood and adolescence (especially abdominal exercises and pull-ups )? Did you only sleep on your side and on a hard couch?
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And I will add . You have very large styloid processes , it will be very difficult to remove them surgically, the incision will be very large
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Thank you for your review. I agree and will try to get a right side styloidectomy with Dr. Osborne. I did and continue to exercise intensively. My eagle’s syndrome developed after being convinced to undergo unnecessary wisdom teeth extraction at 17 or 18 years old ~2011. I have a 2013 Neck CT that showed partial calcification of the ligaments on both sides, a 2015 Neck CT that shows complete calcification on right side, and now 2026 complete calcification of both sides. I believe my symptoms are classic eagle’s symptoms and not vascular symptoms. I do tend to be a side sleeper on my left side and I prefer soft beds.
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I don’t think it’s related to tooth extraction (although it’s possible). I’m more inclined to believe that it’s caused by intense exercise, overexertion in sports, and the possible involvement of calcium-regulating hormones. This can lead to prolonged hypercalcemia.
In my case I can confirm it was caused by 4 molar extractions. We know tonsillectomy and neck trauma can cause styloid calcification, and I recently shared a case report of teeth extraction causing it. Calcification is a healing response to the extraction but was systemic and effected my styloid ligaments instead of the extraction site so I was left with cavitations (voids) and had those recently repaired with PRP by a biological dentist. I also put tension on them from insane amounts of book work for my engineering studies which contributed to the stylohyoid calcificaiton.
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The figures vary as other doctors quote better outcomes for C1 shaves, for example Dr Costantino in his video & I think Dr Patsalides was involved in that too… they also check for other compressions, Dr Costantino resects the posterior belly of the digastric muscle, and mention the occipital artery, spinal accessory nerve, cervical lymph nodes, and sometimes the IJV fascia can all contribute to compression and should be looked for- so some doctors do consider this. We’ve had members also mention the SCM muscle, and omahyoid muscle too as you’ve said. I think it’s still classed as a ‘new’ surgery, so techniques are being improved all the time. The well-known VES doctors that we mention on here usually check to see if the IJV has opened up, and check for other compressions before finishing the surgery.
We have had some members whose symptoms have returned, whether that’s scar tissue, or because the IJV won’t stay open, so sometimes a stent might be needed. Also some members have other issues with compressions which could be contributing to symptoms like issues with the transverse sinus.
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@anon30378544 - The medical articles & doctors in your country have drawn their conclusion about the effectiveness of styloidectomies on an ambiguous premise i.e. styloidectomy doesn’t provide a positive outcome for 60-70/100 patients. That begs the question - How much of the styloid is removed in the styloidectomies they are considering? Many doctors only “snip the tip” off the styloid or shorten a 4-5 cm styloid by 1 cm, not even bringing it to the average styloid length which leaves the styloid stub in contact w/ nerves & possibly vascular tissues as well. Styloids need to be resected to .5 cm - 1 cm i.e. very close to skull base for the best outcomes. The most experienced ES doctors in the US have honed their surgical skills, so in most cases, they are able to cut the styloids that short, & their patients generally have great surgical outcomes w/ a success rate of 75-85%+.
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Dr. Nazaryan and Fedorov have been removing the styloid process since 2018, with about 30-50 patients each year. Over the past seven years, they have treated approximately 300-500 patients. I am aware of four patients who have undergone surgery on both sides, but the results have been either non-existent or partially effective. However, I have noticed that in Russia, maxillofacial surgeons and neurosurgeons often remove only the tip of the styloid process (a small portion of the styloid process). Dr. Osburn removes the entire styloid process and even its base, up to the mastoid process, so I saw an incision even in the ear. As far as I’ve heard, Nazarian has been trying to remove the entire styloid process, down to the root. Other surgeons have also removed styloid processes approximately total 200-400 patients.. Additionally, no one removes the muscles or C1, and they don’t believe in the veins or the vagus nerve.
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They still remove the styloid processes, but only if there are pain symptoms or visible compression of the arteries. If there is only compression of the veins and no pain, they refuse to perform the surgery.
But Dr. Nazaryan and Fedorov remove the styloid processes almost always, and they almost never refuse. Some patients benefit from this surgery, while others do not. They are not particularly concerned about the outcome, and when a patient does not experience positive results from the surgery, they do not delve deeper into the issue or attempt to address it further.
That’s really frustrating that they’re prepared to do the surgery, but not look into outcomes! But we’ve had members who are brushed off by doctors when the surgery doesn’t resolve symptoms, and then are told that the doctor won’t do the second side as the first surgery didn’t help, but for some people both sides have to be done before all symptoms go 
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I agree w/ @Jules that it’s frustrating & not right that the doctors don’t follow-up w/ their patients & do further evaluation if the surgery doesn’t help. There are many medical research papers that have been written about ES, the most effective surgeries to treat it & about IJV decompressions & the most effective ways to treat those. I have to wonder why doctors decline to be more open-minded & keep themselves informed w/ current information. There are US doctors who are the same as those in Russia. I have experienced that with a couple of doctors I’ve gone to.
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I assume that developed venous collaterals (vertebral veins) are a consequence of intense physical exercise. Therefore, when I was 17, physical exercise was much easier to tolerate. At that time, I engaged in intense physical exercise (but I often had nosebleeds — once a week, consistently, or even twice), and the symptoms weren’t as severe as they are now. When a person engages in sports and trains intensely, their blood pressure rises, and due to the increased blood pressure, the thin veins dilate and turn into venous collaterals. When a person stops doing sports and training, the venous collaterals become thin, and the symptoms worsen.
But now there’s another dilemma. Right now, the tone of the neck muscles doesn’t allow for intense physical activity and starting to train. Because when you begin to do physical exercises, your neck muscles tense up and start compressing the vertebral veins, and you feel a worsening of your symptoms. This stage is hard to get through and overcome. And to develop collateral veins, you’ll need intense physical training for about 3 months or more, and that will be difficult given the symptoms.
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@anon30378544 - Exercise may be one reason collateral veins develop, but on our forum, we’ve also consistently seen they develop in people who have IJV compression & who are too sick to be doing vigorous exercise. When styloid elongation/stylohyoid ligament calcification is present with significant collaterals, it’s easy for me to assume the collaterals are due to IJV compression, but what you’ve suggested could also be part of the cause.
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Dr. Nazaryan and Dr. Fedorov from the Federal State Budgetary Institution “National Medical Research Center
of Otorhinolaryngology of the Federal Medical and Biological Agency” (FSBI NMICO FMBA of Russia)
Address: Russia, Moscow, Volokolamsk highway, 30, room 2;
The styloid process are removed for everyone, and the cost is small, about 4 thousand dollars on both sides. They try to remove as much of the styloid process as possible, but as I said earlier, it is often impossible to remove the styloid process at the root. They do operations for everyone, they make money))) They have extensive experience in removing the styloid process (a standard procedure). But they are maxillofacial surgeons and do not touch C1 (they are not legally allowed to remove C1, this is neurosurgery ). In some cases (40-50%), it is sufficient to remove only the styloid process or the styloid process and perform muscle resection (digastric, styloglossus, and stylohyoid). There is no need to perform resection (remove part) of the transverse process of C1.
There’s also Dr. Tereshchuk.
Sergei
Vasilyevich is a maxillofacial surgeon and dentist. He works at the Federal State Budgetary Institution “Main Military Clinical Hospital named after Academician N.N. Burdenko” of the Ministry of Defense of the Russian Federation.
In fact, there are still many surgeons in Russia who remove styloid processes, but they only remove a small number of them, and rarely. And their services are often even cheaper: the cost for one side is about 1,000–1,500 dollars.
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Dr Nazryan and Dr Fedorov were already on the list, I’ve added the others, thanks.
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