Dr. Osborne and Samji both recommended styloid removal. Dr. Constantino says my IJV is compressed and styloid removal is not enough. Can anyone help me verify from these images?
Right side is on the left of this image:
Left side:
Right side:
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@dwg176 see attached annotated images
On your right side your IJV is pancaked against C1. Your right styloid doesn’t appear to be making contact with the IJV, at least at this level and this position. A C1 shave on your right side could be helpful. Also, further down on your right side, your IJV loses contrast or is pinched by something. Wouldn’t know for sure unless I took a thorough look through the imaging.
On your left side, the styloid does contact the IJV. I can’t tell how much compression is happening because the left wing of C1 transverse process isn’t quite in full view at this slice. I think one or two slices higher will give us a better view of the compression on the left.
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Thanks so much for the reply. My c1 is actually a bit higher on the right side (on the left of this image):
So the left side (on the right here) seems to have more room as I go a bit higher:
Most of my symptoms and the longest styloid are on my right side.
It’s hard to know what to do for the best when you get different opinions from doctors! Dr Samji is an excellent surgeon for ‘classic’ ES, ie when there’s no vascular involvement, but he’s not perhaps the best doctor to see for VES, I believe that he’s not too concerned about that, and doesn’t always remove the styloids quite high enough to remove all IJV compression. Dr Osborne is also a very good surgeon, but doesn’t see the need to do a C1 shave, which for some people is enough to take the pressure off the IJVs, but not for everybody.
While I don’t think the surgery should be undertaken lightly, especially having a C1 shave as well as a styloidectomy, Dr Costantino is very knowledgeable about VES, and does look for other compressions while he’s operating ( some members have had other structures compressing the IJVs, like the digastric muscle), to ensure the IJV has the best chance of re-opening.
I hope this helps?
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I will have to follow up with you guys once I have more test results. Right now I am quite confused on how to proceed. I was already scheduled for surgery with Samji because he had an opening for November, but I kept my appointment with constantino for another opinion. I will have to decide if I want to proceed with samji or reschedule with constantino.
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@dwg176 - Dr. Samji did my first two ES surgeries, but I later found out I had IJV compression on the left side & had to have a third surgery with another doctor. I didn’t need a C1 shave but did need my left styloid cut shorter than it originally was. Would have been easier to get the compression taken care of the first time around.
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