@Msdstc It has been a while since we heard from you. How is your recovery from the operation going? I think that one you reported that it has gone well. Any recent imaging to see whether the IJV narrowing improved a bit? You still a have a number of options available to you. I think Dr Hepworth with his vascular surgeon might be an appropriate next steps. See if they can balloon it now that the compression is gone. Given that @TheDude has gone through 6 Styloidectomies (I think the record holder on this one) and finally is satisfied with his last operation by Hepworth should give you some confidence to consider him if there might be some scar tissue left when you first had your C1 shaved in Boston or Dr Aninno. Dr Hepworth found scar tissue on both @TheDude & @blossom thanks to his endavascular coupling with the styloidectomy operation.
@Dobbs - I think you made the right decision having your styloids removed because it’s likely that even if they weren’t the symptoms’ cause prior to surgery, they would have become that eventually w/ how long they were & how close to your C-1.
Brachial plexus compression (what is causing the compression?) + the disc bulge are almost certainly the perpetrators for your hand, arm, & wrist muscle weakness & atrophy. What options have been offered to you to help treat the brachial plexus & disc problems?
I’ll pray that the muscle atrophy improves for you… 
@Dobbs Hi, I live in coastal NC so I saw Dr Hackman when I first heard of Eagle’s syndrome and he offered bilateral robot assisted surgery. I was feeling ok, so I decided to hold off since I’ve also been diagnosed with CCI by Dr Patel and he offered occipital-cervical fusion, which of course I am trying to avoid at all costs. Then I heard about IJV compression by styloids and/or C1, so I saw Dr Fargen the neurosurgeon, who confirmed narrowing on CT w/contrast and will perform angiogram next week. Dr Fargen no longer likes to put stents in before addressing the reason for compression, such as styloids so he would then refer me to Dr Hepworth or Dr Cognetti for styloidectomy and follow up afterwards to see if jugulars are open or if they need angioplasty or stenting. I asked if I could see Dr Hackman for the styloidectomies and Dr Fargen said he only trusts the two above surgeons because they pay attention to the vascular structures, unlike other ENT surgeons who cut through muscles, etc without particular attention to damaging those areas. Good news is Dr Fargen is working closely with Dr Hepworth to learn these skills and be able to perform them in North Carolina, I think he may have already done a couple this past month. And after the styloidectomy he will recheck the IJV to see if it needs ballooning and/or stenting, which an ENT is unable to do. I look forward to having angiogram next week and reporting back on next step. Dr Fargen will also perform lumbar puncture after angio/venograms.
That would be great if Dr Fargen does start doing styloidectomies, it would be helpful to have another surgeon on the list, especially a vascular (?) surgeon! Let us know how you get on!
@NCardinal - I’m excited about Dr. Fargen’s interest in VES. I disagree w/ his assessment of Dr. Hackman, however. Dr. Cognetti has helped some members who have VES, but he typically hasn’t cut the styloids back to skull base which is often the critical step to help resolve vascular symptoms. As far as we have heard, Dr. Hackman does cut back to skull base & keeps an eye out in VES cases to try to make sure the jugular reopens. That said, Dr. Father has his reasons for trusting these two surgeons over others. He’s a doctor, & I can only pass on what I read here based on patient experience.
Here is a post by @Ddmarie regarding her consult w/ Dr. Hackman that may be helpful.
I hope whomever you decide to see for surgery does what you need for a complete recovery. 
I agree, I was very surprised to hear his response regarding Dr Hackman. From what I’ve read of his work, Dr Hackman seems very meticulous in his approach, and I thought 100% Dr Fargen would work with Dr Hackman being they are only about an hour from one another. Thank you for the info on Dr Cognetti, will definitely be looking at options should Dr Fargen find compression next week.
@Isaiah_40_31 the compression is coming from overly tight scalene muscles. I have had issues with TMD, CCI, and postural kyphosis, so any of those could be playing a factor. They likely all are.
Fortunately I have been offered nerve hydrodissection and have an upcoming appointment with another doctor to confirm that plan of action. Will keep posted!
Interesting Dobbs on the overly tight scalenes.
I had to look up “nerve hydrodissection”. Ive had that in the past in the bracial plexus and in my buttocks (psoas area) for scar tissue but ultimately had to do a surgical intervention to remove the scar tissue.
Who is doing the hydrosection? ie: what doc
I am going to the Centeno Schultz Clinic in Denver, CO for this
All - to those who have had ES surgery (particularly bilateral styloidectomy) - have any of you had longterm structural issues?
I am about 6 months out from surgery, and it feels like the stability of my neck, throat, and jaw is gradually worsening (I do have diagnosed craniocervical instability), but just curious as to the experience of others. I was not aware, before the surgery, that the resection of the styloids would mean multiple muscles & ligaments being released.
Particularly those who have had bilateral styloid removal, please share your experience. What I am ultimately wondering is if my neck can get re-stabilized, what the typical life after styloidectomy is like for you (are you active, do you run/play sports/exercise, etc.?). Unfortunately at this point, I honestly have more regret with the procedure than anything - trying to win the mental battle of focusing on what life will look like later vs. now. Thanks!
Yes he removed the styloid process from the base of my skull on both sides to hopefully prevent regrowth.
@Dobbs - do you have a history of neck instability i.e. Ehlers Danlos Syndrome or CCI? We’ve heard that doctors that deal w/ neck instability that styloid removal has no effect on neck stability, but most of our members who have ED or CCI/AAI have said their instability symptoms got worse after ES surgery. One member who stands out as mentioning neck instability is worse since ES surgery is @hyperichard.
I understand the doctors’ point of view in that the styloids really have nothing to do w/ neck stability, HOWEVER, in cases where a person has neck instability & the styloids have elongated, that may have happened to help stabilize the neck so their removal could increase instability.
Hi! Been a while since I’ve posted but yes. My instability has noticeably gotten worse and pain since surgery. My concentration and anxiety also has gotten worse. However, I have been staying positive and will continue to do so, I am warry my story may make people hesitant to get surgery if they need it.
@hyperichard - Thank you for posting. I’m very sorry for your situation & hope you’re able to see one of the CCI/AAI specialists that have been mentioned on our forum. I know you’re trying to finish up school, but have you had time to pursue any additional care for your neck instability?
Yes, I do have a clinical & imaging-backed diagnosis of CCI. Hence, my anterior neck & jaw stabilization is abnormally affected by the styloidectomy. Granted, my calcified styloid was still butting up against my C1 on one side, and causing compression at multiple angles on the other, so it’s kind of a catch-22. Could I have avoided the surgery with CCI treatment? Possibly. But I’ll likely never know. In any case, I have already received my first stem cell treatment for CCI, and my second is in a few weeks. I will keep everyone updated as to that progress, as I’m sure there are others that deal with both CCI & ES. There is DEFINITELY a correlation between these issues in many patients, imho.
I agree with your thought that my styloids may have elongated and ligaments calcified as an adaptation to having CCI. Without historical imaging, I’ll never truly know, but it certainly makes sense as a working theory.
Have you had any treatment for your instability issues? I have experienced those symptoms, as well as MANY others. I am having stem cell treatments done to try to assist. I can keep you updated if you’d like.
Yes please. I am interested in the PICL procedure as a possibility. I have tried prolotherapy before eagles but that was extremely exspensive and didnt help.
I get incredibly tight scalenes on the left side. I’d love to hear what you find out in regards to treatment for this.
I just had my second PICL procedure 2 weeks ago, and so far I do genuinely believe they are helping. I had to get the treatment into my c-spine, cervical junction, and TMJ ligaments, and they are all experiencing (image-shown) instability - so far I would say getting treatment there, while expensive, is definitely worth it.