The AO doc who did the imaging says, the styloids are causing IJV. Thoughts?
Welcome to the forum )).
This is similar to my situation, your left IJV looks wide-open, and you’re right is potentially congenitally small (?). I cannot speak to whether your left IJV would be compromised with head movement. Your styloids come down to your C1 and could be impacting your nerves.
Let us know your symptoms and we provide guidance.
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Actually, I should have said it initially but the left and right are reversed in the image. My right one is the dominant one. I’ll have to upload the radiology report too. I have head pressure, sore/stiff neck, back pain, jaw pain/soreness, I can have headaches, feel like my ears need to pop, facial pressure, lightheaded at times.
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Thank you for these images, @pauld1635. Your styloids are long, but I agree w/ @Leah that it’s hard to tell in the images you posted whether or not your styloids are causing IJV compression, however, I also agree that because they’re very close to your IJVs it may be that when your head is turned right or left or your neck is flexed, your IJVs get compressed. Fortunately it doesn’t look like C-1 is very involved so a bilateral styloidectomy may be all you need. Also, just because we can’t see compression doesn’t mean it isn’t happening. 
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I don’t know if it’s me (& am by no means expert), or if it’s just the angle you were at for the scan, but it looks like your C1 is a little off kilter, and your C spine looks quite straight- military neck, @vdm has posted alot about that…in the 3rd image down several vertebrae look a bit misaligned, hopefully someone better at reading scans can comment on that & hopefully I’ve got that wrong?!
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Yeah, I’m not quite sure how it worked out but I was doing head turns to the left and the right. I do have a straight neck also and am wondering if getting the curve back in the neck has to do with it also.
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The AO doc adjusted my C-1 after that but not sure how it looks at the moment.
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I am no expert by any means. What I am learning is that, unless there are issues with length, nerve impingement etc, then you start with looking at the dominant IJV - your right one. It looks like it is a little compressed but hard to tell. I wish I could see it from 10 different angles. What I am not seeing are giant collateral veins in the back of your head. Could be imaging quality but that suggests that flow might not be too bad through the IJV - that it is managing it…?
I would recommend anyone with suspected vascular symptoms who may not necessarily have nerve issues from styloid alone to get a catheter angio/venogram done before committing to surgery. That will really show you what is going on and what impact it actually has on flow. Dr Hui in Hawaii and Dr Fargen in North Carolina are the two people who I know focus on and can do this extremely well - truly experts. Dr Fargen said he’ll open up someone for an aneurism and see a mangled jugular that looks like it should have significant issues yet the patient has no symptoms. At the same time he will see someone like me with moderate-severe compression but see giant collateral veins and reproduce symptoms on the table that confirm they are at least a cause of some of the symptoms I have. Those tow Drs are in the US so not sure where you are.
And again, if the styloid need to be removed because they are issues in and of themselves then ignore all that I just wrote
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For sure working on getting your cervical curve back could be helpful. There are simple not-to-time-consuming exercises that can be done to help w/ that. You can start by propping your computer up so your screen is at eye level & holding your cell phone up when looking at the screen so you aren’t looking down at it when you use it. A very simple exercise to begin strengthening your neck extensors is to lie on the floor supine (face toward the ceiling). Bend your knees if that’s more comfy, & gently press the back of your head into the floor for a slow count of 5 then relax for a slow count of 5. Do this 5x. You can increase the number of reps gradually over a few weeks. Put your finger tips on either side of the back of your neck while pressing your head into the floor to feel your neck extensors activate. They should feel even on both sides. If one side feels more activated than the other slightly change your head position to get both sides to feel even.
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I was able to get a CTV with contrast done. I don’t have the report yet, but I was looking at it on my own and these images looked interesting. Can anyone tell me what they see?
It looks like the styloid process is compressing the internal jugular vein between it & the C1 process, although it looks like potentially the C1 process is causing more of an issue? Am not a doctor though, & hopefully others more knowledgeable can comment!
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I agree w/ @Jules. I’ve annotated one of your slides so you can see what we’re talking about. Your IJV is distended below the compression area which is typical of vascular compression.
Oh wow, that looks much more informative with the annotations. Is this something that Dr. Hepworth is able to handle? I sent this new imaging to Dr. Constantino to get his opinion since I know he involves the C1 also.
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Yes. Both Dr. Costantino & Dr. Hepworth do IJV decompression surgeries.
If Dr Constantino is taking patients now, he might be a better bet as it looks like the C1 might be involved? Although Dr Hepworth does free the IJV from other soft tissues which can be compressing it too?
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Dr. Costantino has also moved soft tissues that are causing compression. We have one member (sorry I can’t remember who it was) whose accessory nerve was causing the IJV compression, & he was able to correct that situation.
Just got the radiology report back from that recent CTV. Very disappointed that the radiologist said the right styloid isn’t elongated and only discussed the left one. He had the measurement correct on the left one but the right one is actually longer, which is surprising. Should I even bother to ask the imaging center have a different radiologist take a look?
@pauld1635 - YES! Ask for a re-evaluation of the right styloid. The lengths can’t be measured super accurately by the radiologists, & many times a surgeon doing ES surgery finds the styloid(s) to be longer than predicted in the radiology reports. Some doctors will measure the styloids in the CT scans themselves as they don’t trust the radiology reports.
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