Thanks for the good info.
What are you thinking you will end up doing?
I watched a video today by Dr Constantino where he stated Styloid is rarely the culprit and it’s almost always the transverse process which is totally opposite Dr Osborne. This is so hard to navigate.
DB
I have a virtual consultation with Dr. Constantino in September to go over my imaging. I am also trying to get a follow-up set with Dr. Hepworth for further discussion and potentially ordering a CTV (I only have a CTA right now). Still weighing my options, but those are the next steps in the process.
@dbeck177 - You have to remember that every doctor has his/her own opinion, usually based on their experience. I disagree w/ both Dr. Costantino (I’ve watched his video) & Dr. Osborne. vES is not an either or proposition where it’s either the styloids or it’s C1 causing compression. Almost always the two work together to cause the compression problem so both need to be dealt with during surgery. Even though Dr. Costantino takes the stand he does, he often resects the styloid on the side he’s doing IJV decompression, perhaps to get it out of the way so he has better access to the IJV.
I think if nerve pain symptoms are present w/ an elongated styloid, even if it’s clearly uninvolved w/ IJV compression, there is a solid case for a styloidectomy along w/ IJV decompression.
I do agree with @Isaiah_40_31 , it’s not cut & dried that the C1 process is always the culprit, & I was quite surprised by that comment on the video- for me it was purely the styloids causing the compression and I had symptoms resolve after just a styloidectomy. And often members have some nerve pain , ‘classic’ ES symptoms alongside the VES ones…I do think that Dr Costantino usually removes the styloid too, obviously if you did have a consultation with him you would need to check though…