Looking for comments on the severity or the compressions i have and if that correlates to symptoms? Thanks
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Reading this, it’s obvious that you have IJV compression, and pretty significant I would say!
Sometimes the body compensates with IJV compression by other veins swelling and taking over (collateral veins), so despite significant compression sometimes they can be coping. Other times the compression isn’t that severe, but symptoms are as the body doesn’t compensate as well …but even if there are collateral veins, the body gets to a point where it can’t cope any more.
You have the same compression on both sides I think, but one of your IJVs is dominant and the other described as diminutive, which is quite common, but if it’s small anyway, and then both are compressed you would probably notice the compression more…
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Thanks Jules i see on my left side a big vein compensating but not much compensation on the right side that has the greatest compression. Can the body completely compensate or is there always a deficit? There is no compensation for the nerves like vagus i assume? Is the only way to know if the nerves are being affected is by trying surgery and hoping it resolves?
I guess what I’m asking is can the body compensate for the veins but not for the nerves and is the surgery really about fixing the pinched nerves?
I’m trying to get appointments with Dr Constantino, Liu and Nakaji do you have thoughts on who would handle my situation better?
Thanks again
DB
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All 3 of the doctors you mention are experienced with VES, and also Dr Cognetti in PA, they all do C1 shaves as well. If possible we suggest that members get a couple of opinions, and then chose who you feel more confident with?
The body can compensate to a point with the collateral veins, but it does vary- for example some people have a tiny non-dominant IJV from birth, some have even only got one IJV and they manage fine, but others don’t manage well if one IJV is compressed…we don’t know why! If you’re getting symptoms of IJV compression like head and ear pressure, dizziness, off-balance feeling, pulsatile tinnitus for example then that would indicate that the pressure is building inside your head & the veins aren’t coping.
If the vagus nerve is being compressed or irritated, this will cause symptoms, again it does vary but the body can’t compensate for that. Some cranial nerves are visible on a FIESTA MRI, & we presumed that the vagus nerve would also show, but I think Dr Aghayev mentioned on the info video he’s done that the vagus nerve can’t be shown on imaging… But surgery would hopefully resolve this once you’ve healed, although it can take quite a while.
Here are links to videos by Dr Costantino & Dr Aghayev if you wanted to learn more about IJV compression:
A Review Of IJV Compression by Dr Aghayev - General / Research Papers - Living with Eagle
Dr Costantino IJV compression and surgery - Symptoms and Treatments / Doctor Information - Living with Eagle
Hope this helps!
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Thanks Jules
I don’t have the head pressure, i used to have really bad migraines but not anymore. Can IJVC still be effecting me without these symptoms? Like i mentioned most mine are vagal symptoms. Does that typically still justify surgery with my CTV results?
DB
@dbeck177 If that were my radiology report I would read it as surgery is the next logical step. And it typically is a progressive syndrome.
I just saw your images. Your left styloid appears to angle quite a bit inward toward the carotid space. If it is contacting or irritating the carotid artery, that could potentially contribute to symptoms as well.
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Those are some long styloids and the compression is pretty obvious and significant. You had a good read done. My CTV done locally , the radiologist said it was normal. Well it wasn’t normal at all. Thats why it is important to have the surgeon read the scans. I know I had some compression on my right side of IJV, carotid and vagus nerve. I alway like a visual so I have learned how to pull the scan into desktop software and turn into 3D. I can see where the issues are but not all the surgeon did due to my lack of experience.
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It could well be that your body is compensating for now, but as @MGORNEAU says, it’s often progressive. You have pretty significant compression, if it was me I would want to look into getting surgery… As the vagus nerve is in the carotid sheath with the IJV, if the IJV is being compressed it’s likely the vagus nerve is too, so hopefully if you had surgery it would improve these symptoms.
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I received a call from Dr Peter Nakajis office today telling me that after reviewing my CTV i have no Jugular Stenosis and do not require surgery? Why would he say that if my compression is shown on the scan and my styloids are as long as they are?
I’m so confused.
DB
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@dbeck177 Please do not let this discourage you. Your radiology report specifically documents significant compression and elongated styloids which should not have been dismissed so casually.
I had a very similar experience with Dr. Nakaji’s office. They called and told me everything looked normal, even though it clearly was not. I sent them an image showing the area in question, and after that they called me twice asking me to discuss it by phone, but would not address it through email. I never ended up speaking with them again.
I cannot say why he reached that conclusion in your case. He may not believe the compression is surgically significant, may not feel it explains your symptoms, or may simply not want to take on the case.
One surgeon’s opinion does not erase the imaging findings. I would continue seeking another experienced review rather than taking this as the final answer. Sometimes things happen for a good reason. There is a better surgeon out there for your case, you just need to find them 
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Thanks for the reply.
I’m super depressed after talking with them, they would not let me talk with the Dr, i asked over and over how they came to that conclusion.
I thought for the 1st time in my life i had answers and when they told me today i didn’t qualify i wanted to just give up.
Why would he say this when the imaging appears so clear? He is also close to where i live so that part is also discouraging.
DB
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@dbeck177 I understand. I had many of the same thoughts after my experience with his office. My elongated styloids were identified through a Stanford second opinion by a very experienced neurosurgeon in August 2025, and Dr. Nakaji had that information. In my case, I was left wondering whether my complicated history and prior evaluations at major Boston institutions affected how willing he was to become involved. I will never know for certain, but I do know his conclusion did not match what was visible on my imaging.
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Who ended up helping you and was it successful?
DB
Surgeons all have their specific criteria for taking a patient, they might never say exactly what those are, and they might not even tell you all the reasons they turned you down.
More importantly, just because one turns you down, doesn’t mean others will. I’d suggest reaching out to other surgeons for IJV compression on the list. Their opinion of your case could be different and they might well agree to help you. Unfortunately, one can’t know what that opinion will be until one consults them.
If you get opinions from multiple surgeons, you’ll often find they don’t always agree with each other. Unfortunately, medicine (especially surgery) is like that.
Your role as the patient is to sort through what they say, ask questions when you’re unclear, and try to figure out which opinion makes most sense to you. Don’t be afraid to speak up and explain to them what you want.
Consulting a surgeon is a little like a job interview, they’re the candidate and you the interviewer. You’re trying to figure out if you want to work with them and if they are the right surgeon to help you.
I’ve also found it useful not to dwell too much ahead of time on who might be the “one right surgeon.” It’s better to meet the surgeons without those preconceptions and get a sense of who they are, what their surgical approach and philosophy are, what they think about your case, and what they might be willing to do to help you. You will find out who the right surgeon is in time.
Don’t lose heart! You’ve finished the first and hardest step–getting a clear diagnosis!
Your radiology report is very thorough–the radiologist clearly knows a lot about IJV compression and made detailed notes of their findings, and they said you have both elongated styloids and IJV compression from C1. Many patients on this forum have found it very hard to get such decisive confirmation of their diagnosis, and you already have it!
Now it’s just a matter of looking for a surgeon who will acknowledge that report’s findings and take action.
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Thanks for all your help do you have your personal recommendations that might help my search?
DB
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@dbeck177 My bilateral styloidectomies were with Dr. Osborne. He is a very skilled surgeon and surgery was successful in resolving many of my symptoms, but not all of them. Dr. Osborne is an ENT, and my remaining issues involving C1 and C2 require a neurosurgeon.
I do not regret having Dr. Osborne perform the surgery. I had consulted with neurosurgeons, but the options being offered would only drag out what was clearly an issue and I was desperate for help, I could not get those daggers out of my neck fast enough. It was very expensive, though, and they have not been helpful while I have been trying to obtain reimbursement from insurance. But I believe I ended up going down that path for a reason; I am just not sure what that reason was yet.
So Dr. Osborne will not address your C1. He believes cutting the styloid above the compression is sufficient, which may be true in many cases, but it was not enough to resolve some of my worst symptoms. Based on what you have shared, I think your case may be better addressed by a neurosurgeon, and I would personally recommend consulting Dr. Liu in New Jersey. He and his team are very down to earth and Dr. Liu seems willing to think outside the box and look at the whole picture.
If you do see him, go in confidently and do not be afraid to speak up. The intake questionnaire is long, but it is important to complete it in detail. I had ChatGPT help me articulate my responses so they were clear and organized. I also watched quite a few of his videos, he is impressive.
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I’m sorry that he’s not wanted to offer you surgery, but the others have given you very good advice- we don’t always know why doctors turn patients down, Dr Nakaji has done this with other members. It’s particularly frustrating as he’s closer to you than the other doctors, but you have a very thorough radiology report, so don’t give up and try with one of the other doctors mentioned.
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@JGont has just been turned down by Dr Nakaji too, so you’re not the only one…
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Hello @dbeck177 , yes I just had a conversation earlier this week where Dr. Nakaji did not recommend moving forward with surgery.
Dr. Osborne stated the imaging was “not a slam dunk” but that my symptoms aligned with Eagles. He stated if I were his patient he would recommend moving forward with surgery.
Dr. Hepworth recommended moving forward with surgery after reviewing my CTA and his ultrasound.
I feel for you, it’s very difficult trying to determine the right course of action. I think you should keep advocating and try and find a surgeon who will take into account the whole picture. You are not alone in this!
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