I just meet with an ENT today to talk about Surgery for my ES. He didn’t have much info to offer. He has only done about 3 in his career, and he couldn’t tell me if there was vascular involvement or not with my ES. It seemed like to him there was no difference in the way surgery is done. It’s just removing the styloid. He told a story about a patient who passed out turning his head and removing the styloid fixed his issue. What would happen if you had vascular ES but only had the styloid removed?
I have symptoms for both vascular and neurogenic. Vascular symptoms are:
Pressure Headaches behind eyes and base of skull
Chronic tinnitus
Base of Neck warmth when chewing
Brain fog & mental fatigue
If I simply got my styloids out, would these symptoms stay? and if so, why?
@Bay - You asked good questions. In some cases the IJV(s) are being compressed by the styloids. In others, the IJVs are sandwiched in between the styloid(s) & transverse process(es) (TPs) of the C1 vertebra, & sometimes the TPs of C1 are the main compressor. In the latter two scenarios, just having the styloids removed still leaves the IJV(s) compressed to some degree, or fully, thus a surgery to shave the TPs of C1 would still be necessary to get vascular symptoms relief. In the first scenario, simply having a styloidectomy would allow the IJV(s) to decompress. @Jules had that experience.
Do you have access to your imaging or can you get a CD or soft copy that you can use to create 3D images using either radiantviewer.com (PCs) or Bee Dicom Viewer App (Macs)? We are happy to look at your imaging & try to help you discern whether your IJVs are compromised only by your styloids or if C1 is also involved.
I’m sorry the surgeon you saw wasn’t more helpful in communicating your situation. If your CT was done w/ contrast, & he looked at it prior to your appt. or while you were there, he surely could have provided you w/ the information I just mentioned.
He looked at it before I came. When I asked him about the IJV or the C1 he had no idea what I was talking about. I was hoping that we’d be able to look at the scans during my visit with him. But all he had was the lab report on hand. So I had to contact the facility that did it and then turn in a form via email and now I have to wait for them to send it to me in the mail. I’m kind of annoyed. I would’ve asked for that sooner had I known that was their process.
That’s a shame he wasn’t more knowledgeable & hadn’t got all your info, very frustrating!
I would just add in that it’s not necessarily that the surgery is done any differently, it’s whether the styloid is cut short enough to relieve any vascular compression. It sounds like you could have IJV compression, and that quite often happens fairly close to the skull base, so if the doctor only shortens the styloid a bit to make it more ‘average’ length then you could still have the IJV being compressed & so the surgery may not help you.
The patient the doctor mentioned sounds like they had carotid compression with head turning as passing out with that is a typical symptom, and luckily the doctor obviously removed enough of the styloid to avoid the compression.
Obviously without seeing your scans we can’t comment for sure, but it could well be you need a doctor experienced enough to remove the styloid close to the skull base, or the surgery might not resolve your symptoms.
Not that this helps the current situation which is very frustrating…I always ask for a copy of the imaging study at the time of the appointment. It usually only takes them a few minutes to burn it on a CD and then I have it in hand. It’s always good to have a copy filed away. I hope you get some answers soon!