Compression of the two IJV and unsuccessful surgery in Russia

General
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Hi. On August 21, 2026, I attended an appointment with neurosurgeon Dr. Hayrapetyan Artem Armenovich (consultation) and maxillofacial surgeon Dr. Ara Sargisovich Khandzratsian at the State Budgetary Healthcare Institution of Moscow “F.I. Inozemtsev City Clinical Hospital of the Moscow Department of Health” address: Russia, 105187, Moscow, Fortunatovskaya str., 1. Doctors Ara Sargisovich Khandzratsian and Artem Armenovich Hayrapetyan are ready to perform a surgical operation on me, a revision surgical operation (a repeat operation on the right), the date of the operation has not yet been announced. But they will only resect the stylohyoideus muscle, the styloglossus muscle and the digastric muscle, but they will not touch C1. Dr. Artyom Hayrapetyan will act as an assistant, as at the moment he does not know this area yet, and refuses to operate on himself and shave C1, as he does not want to harm the patient. Perhaps in the future he will shave C1. They also both say that revision surgery is very difficult, and not every surgeon will undertake revision surgery. In principle, Dr. Nazaryan or Fedosov most likely can also possibly perform a similar revision surgery. As for C1, I wondered if it was possible to do without shaving C1, in my case, in the pictures it looks like i can’t shave C1 (a difficult choice). But Dr. Khandzratsian said that even if you resect part of the stylohyoideus muscle, the styloglossus muscle and the digastric muscle (in theory, this will free up enough space), fibrosis/adhesions can still form and there is no guarantee that compression will not happen again (perhaps that’s why neurosurgeons tend to resect part of C1 to free up more space). Of course, it is risky not to shave C1, but according to my CT scans and in my case, I believe that it is enough only to resect part of the stylohyoideus muscle, the styloglossus muscle and the digastric muscle(in general, a difficult choice). Dr. Hayrapetyan Artem Armenovich, also performs surgical operations on Kimmerle (ponticulus posticus,Arcuate foramen ), he is a student of Dr. Viktor Alexandrovich Lukyanchikov. Dr. Hayrapetyan Artem Armenovich said that they know the technique of transplanting fat from the abdomen to the incision area to reduce fibrosis/adhesions. But he recommended a more effective preventive gel against fibrosis / adhesions - Antiadgezin gel (it is applied to the tissue during surgery). But for some reason, I did not have a fat transplant from my stomach into an incision, and I was not offered this gel during my surgery on July 9, 2025.

Dr. Khandzratsian also confirmed that my symptoms are similar to those of patients who had their internal jugular veins (even one) ligation (dissected). It happens that the internal jugular veins of a patient with neck cancer are dissected . Also, those with neck cancer and some kind of education also have such symptoms. Now there is a technique for dissecting the internal jugular veins (they do an anastomosis/bypass of the internal and external jugular veins )

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I’m glad that you’ve found doctors to do your surgery, and hope that the muscle resections are enough to stop compression. I wonder why they didn’t use the techniques to stop scar tissue, hopefully there won’t be too much found when they get in there!

Have you got a date for surgery?

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Hoping this is the answer for you! These doctors seem very educated on your case which is wonderful! Wishing you success.

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Obstruction of Venous Drainage Linked to Transient Global Amnesia

doi: 10.1371/journal.pone.0132893

Some this radiopaedia dot org/cases/aortosternal-compression-of-the-left-brachiocephalic-vein

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@anon30378544 - That’s good news that you’ve found doctors willing to do a revision surgery for you. When you mentioned the possibility of post op fibrosis/adhesions forming, I immediately thought of the procedure Dr. Aghayev does using belly fat to prevent or reduce problems from that. Dr. Hepworth, in the US, uses sterile sheep gut which is wrapped around the IJV to “reinforce” it’s outer walls so they don’t collapse from pressure caused by post op fibrosis/adhesions/scar tissue. Even if taking the extra step to protect the IJV once it’s decompressed isn’t common, it’s at least being done by some doctors. It’s good that the surgeons you’ve seen also have a technique to help protect the IJV post op.

I know it’s a gamble for you to have a revision IJV decompression surgery & not have C1 shaved, but if you agree with what your surgeons see on your imaging, & with the procedure they have suggested, then it will be good for you to have surgery in your own country & not need to travel abroad to get the care you need.

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We have three surgeons in Russia who deal with TOS, which I have heard about.
Sergey Anatolyevich Grachev is a student of the Lithuanian vascular surgeon, Povilas Pauliukas (150062, Yaroslavl, Yakovlevskaya str., 7). It is he who claims compression of the vertebral artery at the entrance to the transverse process C5 between the anterior scalenus muscle and the long neck muscle/Musculus longus colli (dynamic or partial permanently)
Shchipakin Vladimir Lvovich is a cardiovascular surgeon. Shchipakin also focuses on the vertebral artery, which surgery technique I do not know, and neither do the patients (I think they do not touch the long neck muscle). (RCNN; Russian Ctr Neurol and Neurosci, Moscow.)
Irakli Ilyich Tsuladze is a neurosurgeon. He partially speaks about the vertebral artery, but more points to nerves (the stellate nerve , the parasympathetic nervous system) (125284, Moscow, 2nd Botkinsky ave., 5 (S.P. Botkin State Hospital), building 22, floor 5, sector A, office 5021.). None of the above surgeons believe in veins at all. Although Tsuladze wrote an article about venous drainage in 2012, now he does not believe in veins at all. Let me remind you that Dr. Lukyanchikov also does not believe in veins.
I was initially\earlier very skeptical about this dble surgery, but now I’m thinking about it (it’s quite real).
As a result, I know several patients who have been helped by this operation (Dr. Grachev removes the anterior scalene muscle and part of the long neck muscle, Dr. Tsuladze and Shchipakin remove the scalene muscle and the first rib, but they do not touch the long neck muscle). So, most of the reviews and patients who received a positive effect from Dr. Grachev.Of course, it can be assumed that free space is being released for the vertebral veins, and the vertebral veins have been compressed, but… Of course, there are patients who have worsened their symptoms or have not had an effect (now Dr. Grachev performs surgery on both sides). Those who got worse after surgery, most likely just got compression of the vertebral veins with fibrosis.scarring or an unsuccessful operation. But only some of the symptoms are mild from the veins (fog in the head, and intracranial pressure, although it may also be vertebasilar insufficiency from the vertebral arteries). Symptoms such as dizziness, ringing in the ears (not all, but most of them), photopsias and spots in the eyes ((not all, but most of them), transient ischemic attack - these are all more likely from the vertebral arteries . I also don’t really believe in veins anymore, if there are any symptoms from veins, then it is very limited and not all the symptoms that are written about in articles about veins are related to them.Of course, I agree that a chronic and prolonged violation of venous outflow can lead to Alzheimer’s disease and dementia. But I already attribute most of my symptoms to the vertebral arteries or nerves in the aperture. Here is an article by Dr. Pauliukos, there are CT scans and angiograms, evidence_:

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@anon30378544 - Is there a way to translate the medical research article in the link you posted into English? I am not very techy & it was too long to have translate.google.com do it. It sounds like an interesting article so I would like to read it.

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This is an old article, back in 2003, and it’s partial and also in Russian.Use your translator.The main symptom of problems with the vertebral artery is severe dizziness, constant ringing in the ears (there may also be headaches, migraines, spots in the eyes). Moreover, there is an inaccuracy in the article above, I would argue with the statement “about compression of one vertebral artery and tinnitus on the same side.” Lithuanian surgeon Pavlikus Pauliukas may have come to Russia to train other surgeons in this operation before, but he visited Dr. Grachev in Yaroslavl sometime in 2016 (vesti-yaroslavl(dot)ru/novosti/item/13409-yaroslavskie-khirurgi-nachali-provodit-operatsii-na-pozvonochnykh-arteriyakh). Dr. Grachev and his team and Dr. Tsuladze operated on at least 150-300 people each. Dr. Grachev and his team are probably even more than 300 people. And I’ll tell you honestly, too, that not all patients received a positive effect, many patients did not receive an effect, and some of them got worse, I assume 30-50% did not receive a positive effect (which is probably most likely due to compression of the vertebral veins and the mouth of the internal jugular vein with fibrosis) Everything is individual, this does not mean that the vertebral artery is the solution to all health problems, since Eagle syndrome is not a panacea for all health problems. There may be two health problems. For example, numbness of the fingers, especially after physical exertion, cannot be attributed to Eagle syndrome - this is TOS. etc… We need to look more broadly and understand the problems, and not attribute all health problems only to Eagle syndrome, or to TOS and etc/…;..

Dr. Agaev and the other colleagues mentioned do not believe in the curvature of the vertebral artery and stenosis at the mouth of the vertebral artery (he also does not know about the tendon longus muscle of the neck ). Every surgeon has his own opinion, and everyone is right about something. But the full picture of the problem is rarely obtained))) At the same time, neurosurgeons focus more on nerves, and vascular surgeons believe more in arteries)))). There are also diagnostic problems in all countries (MRI, CT, angiography, and tests). Radiologists do not want to overwork themselves and deal with an unusual problem, they do a scan using a standard protocol. Time goes by, but the money is dripping)). Why waste your energy if you can only do standard procedures)))

hypoplasia of the vertebral artery is often due to inflection of the mouth of the vertebral artery (due to the curve of the vertebral artery or compression due to compression of the sympathetic nerve). But still, there are patients with severe hypoplasia of one vertebral artery((with or without circle of Willis)) and they do not have any symptoms (asymptomatic). As all surgeons say (including Dr. Agaev), everything is complicated (difficult to understand) and there is a problem with diagnosis.

The laws of hydrodynamics are complex (hard to understand). The ways of the Lord are inscrutable. )))) .But the engineer has an understanding. However, there are also problems with diagnostics, poor quality, and dynamic compression. Not everything is visible on CT scans, and a trial in motion is always needed.

And everything is simple here on the forum- the Eagle syndrome is to blame for everything problems health )))):grinning_face:

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So. Problems with veins carry certain symptoms, I would like to separate the symptoms from the veins, the symptoms from the arteries and nerves. Otherwise, everyone here on the forum likes to get smart and put everything in one pile, Eagle syndrome with compression of the veins or nerves or arteries is to blame for everything. I will not mention facial pain or problems with swallowing (dysphagia). And let’s start with the fact that numbness, tingling of the little finger and ring finger (especially when raising your hand, or after physical exertion) is more of a TOS. And the tension of the neck and shoulder muscles is also more related to TOS, and possibly to Eagle syndrome.

  1. Stenosis (compression)In hydrodynamics, this is a local resistance that affects blood flow (fluid flow, volume velocity of blood flow). The entire artery and vein chain is one pipeline with its own linear and local resistances that affect blood circulation in the brain. The arteries cause a local critical shortage of blood, and the veins only reduce the volume of blood, since there are many veins, many collateral venous and vertebral veins. There are also anamostoses (bypass) in the arteries

  2. Having developed venous collaterals, the vertebral veins are on both sides and are passable throughout the neck, right up to the heart. There is a high probability that you will not have symptoms related to the veins. But there are people who do not have developed collateral veins, vertebral veins (compression of neck muscles, genetics)

  3. If there is an insignificant stenosis on both IJVs, then you may not have any symptoms related to the veins. Approximately: insignificant stenosis of about 60-70% is a decrease in the cross-section of the vessel (tube), does not significantly or critically affect blood flow.For hydrodynamics, this is an insignificant stenosis and has little effect on blood flow. And if you have compression of about 60% of the two IJVs in the C1 area, and there is no compression elsewhere, and the transverse venous sinuses are normal, you may not have symptoms related to the veins. Especially if there are additional developed venous collaterals. Look for the problem of symptoms elsewhere.

  4. So, venous symptoms will definitely be 100% with compression of two IJVs, significantly about 80-90% or higher, and undeveloped venous collaterals.

  5. Now about the difficult part :
    a) Dynamic compression of IJV, during sleep, and symptoms during or after sleep. This can also happen, and therefore a person after sleep can be angry, tired and with a fog in his head. But there should be relief during the day.
    b)With one IJV open, the pressure measurement will not show a high pressure gradient (these are the laws of hydrodynamics). The pressure sensor is inserted into the transverse venous sinus, and the left and right transverse venous sinuses are often connected (it rarely happens when they are not connected)- this is one vessel/volume. Therefore, the pressure sensor will not show a high pressure gradient when one IJV. there will be a slight difference in the measurement values.
    Example: I roughly calculated the pressure difference before (right atrial) and after C1 (torcular pressure) , without compression. And I will say this, that pressure losses (difference ) equal to 2 mmHg or less are very minimal values and very good, i.e. very ideal. In reality, this value is higher (even the calculated value). The calculated value without IJV compression is approximately 2-5 mmHg, and articles indicate 4-6 mmHg. Therefore , 2 mm . The mercury column is a very ideally low pressure loss. Theoretically, the gradient (pressure difference ) is 2 mm. a mercury column is possible, but these are very low pressure losses, ideal. I suspect that they did not take into account all the nuances during the measurements. Do you have developed facial veins, they were measured just after the facial veins and before C1.

    The second is that the left IJV is compressed more strongly and why is the pressure gradient there better (less)?:slightly_smiling_face: They wrote the threshold value of the anamnal pressure gradient of 2 mmHg, but in the articles they write that the threshold of the pressure gradient is more than 5-8 mmHg (perhaps they did not fully understand these measurements. An increase in pressure by 2-3 mmHg, even from a medical point of view, makes no difference.In general, there are a lot of questions about such measurements and the doctors who made these measurements). What is the pressure measured in the transverse venous sinuses (10-15 mmHg or higher, for example 20-30 mmHg)? In your case, it’s not the pressure gradient that will tell you more, but simply the pressure in the transverse venous sinuses. Share the full report and DSA snapshots.
    In fact, you need to take a lot into account when making measurements, but doctors are not engineers and they cannot understand all the subtleties of hydrodynamics. So I don’t think there are doctors who can take all the details into account.
    In the sigmoid venous sinus, there are several angles-turns and bends. And in this place there can be no complete absence of pressure losses (zero gradient) or extremely low pressure losses. There will be low losses when there is a bypass bypass nearby, when the pressure is balanced due to another branch. Or the measuring point has a different compression below, and then the pressure also comes into balance at two points. For example, below is the compression like yours, where is the bifurcation on the left. There are a lot of subtleties in hydrodynamics, doctors are not engineers.

  6. с) This question is of interest to me. Also, according to the laws of hydrodynamics, when there is strong compression on one side and there are no developed venous collaterals / vertebral veins on the same side (despite the absence of pressure), in the area of the brain (cerebellum) locally next to the transverse venous sinus, there is a decrease in blood flow velocity, stagnation of blood , due to high vascular resistance on the on this site.This is clearly visible on the MRI venography, and hypoplasia of the transverse extra-venous sinus is mistakenly diagnosed. In fact, this is false hypoplasia, and it appears due to compression of the IJV.I have hypoplasia on the left, and I had a terrible headache for two months on the left at the age of 14.I also wonder if symptoms such as vertigo and photopsia, as well as transient ischemic attack due to veins, especially when the IJV is compressed on one side, apply. I think these symptoms relate more to the vertebral artery (to the arteries) than to the veins. It is possible that on the same side where the IJV is compressed, there is also hypoplasia of the vertebral artery or other problems, and problems with venous outflow cause only partial deterioration. And dizziness or fainting is caused by problems with the vertebral artery. Therefore, many patients receive only partial relief.

  7. The laws of hydrodynamics are complex (hard to understand). The ways of the Lord are inscrutable. )))) .But the engineer has an understanding.:grinning_face:

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Interesting theory about the vertebral artery’s involvement in vascular symptoms. It certainly bears looking into for patients who don’t have good results with IJV decompression surgeries alone.

Here are links to two medical research articles sent to me by @Snapple2020 which give information about venous sinus stenosis & it’s possible relationship to pulsatile tinnitus. These will be helpful for those who still suffer from pulsatile tinnitus months after IJV decompression/styloidectomy have been done. The article in the second link was written by Dr. Patsalides whose name has been mentioned on this forum:

https://neuroangio.org/sample-page/diagnosis-and-treatment-of-pulsatile-tinnitus/pulsatile-tinnitus-venous-sinus-stenosis/

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And where did you see that I denied throbbing pulsate tinnitus with vein problems? But there may also be permanent tinusitis due to the vertebral arteries, there may also be pulsating tinnusitis due to the contact of the cerebellar artery with a nerve, due to a tumor (as it says in medical articles):wink:

In general, such measurements are very difficult. Pressure gradient measurement (pressure difference) . I do not know if two sensors are used to measure pressure at the same time or not (at the same time). Since the pressure in the veins can change rapidly over time (especially by a small amount of 5 mmHg), it also depends on breathing and heartbeat . It is a little easier to measure blood pressure in the transverse venous sinus and compare them with the data from examinations on healthy people. But here, too , you need to take into account your heartbeat and blood pressure , i.e. these are all input data (parameters must be monitored). It’s all very complicated. So such measurements are wrong in conception . Moreover, doctors are technically not very literate, they have other knowledge. In our country, all doctors of ultrasound diagnostics (Doppler scan) made mistakes when measuring blood flow rates in the arteries. They measured the speed of blood flow at corners, turns, and at the point of curvature of the artery vessel, and did not adjust the angle in the program to correctly display the speed value. And they had greatly overestimated blood flow rates, which they mistakenly interpreted as stenosis, i.e. they falsely concluded arterial stenosis when it was not in this place. I pointed out this error to them, and some ultrasound doctors are now correcting the angle in the program

I saw CT scans of a person with a head turn. In the C1 area, there was decompression of the IJV on one side, but not on the other. There was also compression of the IJV between the anterior scalene muscle and the SCM. Dynamic compression. And the pressure will also change.

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I made no such claim.

I only provided the information in the links for our members in general. It was not there to counter anything you’ve said.

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So, I have some news. First, I’ve been assigned a date for the surgery, and it will be very soon. But I won’t tell you)))) Second.
So I’ve had CT scans with contrast four times since 2022 (I could have done only two, but the first time I had a CT scan without venography, the second time I had a CT scan with venography, but the pictures were bad, the third before surgery in 2025, and the fourth CT scan only of the artery after surgery).

I’ve also had an MRI scan only eight times since 2021 (two of them were spine and abdomen, one was unsuccessful). I had an MRI scan of my neck (six times, including the last MRI on September 03, 2026 and the failure, the scans were not given to me). It’s hard for me to lie on my back for a long time. No MRI shows axial sections/images in the C1 region (except for the 2026 MRI). I went around and called quite a few hospitals (about 10 of them) and everywhere the MRI radiologist refused to do a scan of the C1 area, they said they couldn’t do it, they didn’t know how.

On September 3, I came to the City Clinical Hospital No. 67 named after L. A. Vorokhobov(Moscow,Russia). Firstly, the hospital underwent major repairs, and new MRI machines were installed - Siemens Magnetom Altea 1.5T.

I talked to an MRI radiologist (this is even an Associate degree level), and she replied that she would do the C1 area without any problems, that it was not difficult. I understood that it was possible to do this, but I was already used to refusals and did not expect a positive response))))) This radiologist girl is doing great,she’s a professional in her field !!! :+1: I was just pleasantly shocked ))))

So, she captured the C1 area during MRI scanning, with a slice thickness of 3 mm (everything is clearly visible in this area), and she additionally and re-launched MRI scanning of only the C1 area with a slice thickness of 1.5 mm (but alas, I was breathing heavily and these images were practically useless).The MRI scan took 16-17 minutes (including 4-5 minutes for additional and repeated scanning with a slice thickness of 1.5mm, in the C1 area). this scan cost me less than $100.

I have also noticed a very important symptom three times already. Especially twice, when they did an MRI scan (and this time I felt sick when she scanned the C1 area again). My tongue went numb for 5 minutes, during the scan, my chest was squeezed (it was hard to breathe, as if they were pressing on my chest), all my fingers were temporarily numb (paralysis of the extensors of the hand and fingers).It all went away after 8-10 minutes (I tried to stretch my shoulders and neck\I did exercises). This may be due to nerve vibrations due to electromagnetic waves.

After examining the MRI scans, I was upset. My fibrosis/scar tissue has hardly changed and it compresses the right vein completely, and the IJV itself has become thinner, i.e. the outflow has worsened (perhaps a vein has been damaged or fibrosis has squeezed/compressed the facial vein).In other words, surgical surgery performed in 2025 was pointless and ineffective, or even worsened the condition.

here is my MRI scan at the C1 level:

www drive google com/file/d/1x4ariaUo-TRWggYGaLAkvbloOMxc5BXZ/view?usp=sharing

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Dynamic compression of the vertebral arteries is often not visible on MRI or even CT scans. It is visible only on DSA arteriography with head turns.

"….the cerebrovascular clinic with intermittent dizziness when turning his head to the right."

Bow Hunter’s Syndrome

Robert W. Regenhardt, MD, PhD robert.regenhardt@mgh.harvard.edu, Mariel G. Kozberg, MD, PhD , Adam A. Dmytriw, MD, MPH, MSc , Justin E. Vranic, MD , Christopher J. Stapleton, MD, Scott B. Silverman, MD , and Aman B. Patel, MD Author Info & Affiliations

Stroke

Volume 53, Number 1

doi /10.1161/STROKEAHA.121.037253

and another … its many article

“… The dizziness was aggravated when the right side of the neck was turned and the body position changed”

Am J Case Rep. 2024 Apr 12;25:e942609-1–e942609-7. doi: 10.12659/AJCR.942609
Bilateral Bow Hunter Syndrome Associated with Loss of Cervical Physiological Curvature
Shengwu Wang 1,A,C,E,:envelope:, Youcai Bi 1,B,C, Yunbo Chen 1,A,B
Author information
Article notes
Copyright and License information
PMCID: PMC11020505 PMID: 38605499

Bow Hunter’s Stroke
Home / For Providers & Researchers / Education / Publications & Video Series / Barrow Quarterly / Volume 17, No. 2, 2001 / Bow Hunter’s Stroke
Authors

G. Michael Lemole, Jr, MD
Jeffrey S. Henn, MD
Robert F. Spetzler, MD
Joseph M. Zabramski, MD

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona

Abstract
@he signs and symptoms of vertebrobasilar insufficiency range from dizziness, nystagmus, and nausea and vomiting to frank hemiparesis, sensory changes, Horner’s syndrome, swallowing difficulties, and loss of consciousness. Symptoms may be transient in the case of temporarily compromised blood flow or may persist when insufficient blood flow or resulting embolus or thrombus produce an infarction in the affected vascular territory. The extracranial vertebral artery usually becomes occluded when the head is rotated while the artery is fixed by surrounding bony or fibrous structures. @

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As I wrote earlier about muscles and C1. Muscles are attached to the transverse process of C1 at the very edge, and accordingly, with partial resection of C1, these muscles may be cut off or partially damaged. And muscle damage is fibrosis/fascia. See the areas on C1 in the MRI image. As I said earlier, the muscles are clearly visible on the MRI, and you can see where they are attached to C1

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I can only presume, as these muscles seem to be pretty useful, that surgeons wouldn’t be detaching them, I think it’s a good question for people to ask their doctors if looking at getting a C1 trim. Perhaps as often members who need this have longer than average C1 processes, maybe enough can be removed before getting close to where the muscles are attached?

I’m sorry for your situation, that the surgery might not have helped. I hope that the surgery you’re due to have soon does more to help you… :folded_hands:

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To do this, I need to see CT scans.MRI scans after surgery from different surgeons. So far, I’ve seen one surgeon from the forum after the operation, and in the pictures, one muscle was clearly cut off on one side (a lot of C1 was shaved off). I do not know how traumatic it is or not.

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I just saw the CT scans of another patient after the surgery. C1 has been removed even more, and the muscles have been cut off on both sides. (i.e., I’ve already seen two patients treated by this surgeon).

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Some members have said that their neck feels more unstable after surgery, others haven’t felt that, so I guess it’s possible it’s the muscles being detached in theory. It would be helpful if one of the doctors would clarify this- Dr Aghayev in the video states that quite a bit of the C1 process can be removed without any harm, but he’s never mentioned detaching muscles that I can recall…

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