@dbaiada - From past members’ posts, I’d say the difference between Dr. Cognetti’s & Dr. Costantino’s approaches are that Dr. Costantino always removes the body of the posterior digastric muscle, always cuts the greater auricular nerve (to make skull base styloid access easier & which is then repaired by Dr. Tobias prior to closing the incision), & always has Dr. Tobias remove the full transverse process (TP) from the C1 vertebra. He also checks the IJV for compressions other than that caused between styloid & C1.
As far as I know, Dr. Cognetti & Dr. Heller’s approach may not be quite so “formulaic” in that each patient’s case is treated as they deem necessary vs doing specific steps for every patient whether they may be necessary or not. Since you’ve watched Dr. Costantino’s YouTube video, you know he justifies his approach by the claim that, in his experience, it produces better overall & long-term outcomes. I don’t doubt that, however, we’ve had quite a number of members who’ve had very successful decompression surgeries w/o losing their posterior digastric muscle & the full TP of C1. That’s to say, I think the case by case approach is more ideal, but I’m not a doctor. I’m not sure whether the Drs. Cognetti/Heller team look beyond the styloid/C1 compression point or not. That would certainly be worth asking about when you meet with him. IJV compressions can also be caused by nerves & other blood vessels lying across C1, or scar tissue, fascia, muscle, /or lymph nodes crushing the vessel, often below C1. It’s important for any surgeon doing IJV decompression surgery to follow the IJV from skull base to collar bone to make sure all compression points are dealt with.
In case you haven’t read this post, it has good information about the surgery & questions to ask when consulting a doctor. You can add the things I’ve suggested above to the questions list, & of course, any other questions you have.