Has anyone had VES surgery with Dr. Nakaji and willing to share your experience with it?
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Here’s a link to a discussion and an article @KoolDude posted about him, it might be helpful:
CT Scan Pics, broken styloid or scan error? Compression? - General - Living with Eagle
He did my 1st surgery, styloidectomy with C1 shave. Had a hard time talking him into it, I had to have my neurologist convince him. This was when he was at Barrows, back in 2014. Not sure what you want to know. I did have a complication afterward. I couldn’t swallow at all, not even saliva. I ended up in the hospital for a week, with a feeding tube, until I could start eating soft foods. But the surgery resolved my symptoms completely, the worst being a 24/7 headache. The headache did return 5+ years later, at which time he declined to do surgery on the other side. I was fortunately able to find someone else to do it and although my headache didn’t completely resolve afterward, it did lessen greatly (from an 8-9 down to a 2).
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Good to hear from you. I’m sorry for the complications from your first surgery & also sorry to hear that Dr. Nakaji wouldn’t follow through & do a second surgery for you. It’s good to know you found another doctor to do the second side, & I’m glad your symptoms are greatly reduced. 
Did you have a C1 shave as part of your second surgery? If so, do you mind sharing the name of the doctor who did your surgery? We would like to add more doctors who are competent with vascular ES surgery to our Doctors List as we only have 2 or 3 in the US at the moment.
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My 2nd surgery did not include a C1 shave, although going in, it was an option. Dr. Lawton, also with Barrows, officially did my 2nd surgery. But according to the surgical notes, it seems it was mostly Dr Santarelli, an ENT, who took the lead. If a C1 shave had been necessary, he would not have been able to do it. I must add, prior to my surgery, he (Santarelli) seemed very skeptical of the whole idea of vascular Eagles. I saw him before seeing Lawton, and he kept harping on the fact that I didn’t have symptoms of classic Eagles. I wasn’t happy when I found out he would be assisting Lawton. I don’t know if doing my surgery changed his mind at all. And I don’t know if a C1 shave had been done if my headache would have completely resolved.
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@Susie Thanks so much for sharing your information. Was there something about the surgery that left you unable to swollow temporarily? That must have been very scary.
Also, other than headache pain, what other symptoms were resolved or improved by the surgery?
I’m flying to Phoenix in a couple of weeks to consult with Dr. Nakaji. I hope I don’t get turned away.
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@Susie - Dr. Samji did my surgeries & he is also in the camp of very skeptical of the whole idea of vascular Eagles. I got good results from my surgeries but have unitlateral hearing loss which may be related to recently discovered IJV compression. It’s disappointing to think I might be hearing better today if the IJV had been decompressed during my ES surgery 9 yrs ago. C’est la vie!
I don’t know if you’ve been keeping up with the latest info on vascular compression on this forum, but we’ve had several members who’s CTs showed compression of the IJV between the styloid & C1 but in the end, the compression was being caused more predominantly by a nerve (accessory), muscle (posterior digastric) or artery (occipital). Having a styloidectomy & C1 shave wasn’t the full answer for those members. Besides those I listed, I suspect there may be other nerves, muscles, &/or arteries/veins that could cause occlusion of the IJV as well.
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He said it was really tight in there, I got the impression it was worse than the imaging had showed. If I remember right, he said they had to tug on a bundle of nerves. It didn’t damage them, but irritated them, so the swallowing problem was only temporary. It took several months before I could eat normally again. He said he didn’t want to do the second surgery because he didn’t think it would help, as my symptoms had returned years later. I never understood that reasoning, since prior to the 1st surgery he said I might need the other side done. But I suspect the complications from my 1st surgery gave him pause to do surgery again.
I know I had other symptoms before the surgery, but the headache, since it was so bad and unrelenting, was the major one by far. I remember my voice getting tired if I talked much, I had occasional episodes of my eyelid blinking really fast and then closing without me being able to control it, and I think some episodes of feeling like I was on a ship. I think there were others, but nothing that affected me like the headache.
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@Susie , I’m glad that things have improved for you, a shame the headache didn’t go completely…thanks for taking the time to come back on to give @Chrickychricky some info 
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Yes, thank you so much! I also think it is interesting that he didn’t want to do the other side but a few years later co-authored the paper @Jules referenced earlier in this topic where they wrote that for bilateral cases it was their protocol to start with the non dominant side and then decompress the dominant side. I will definitely post after my appointment with him on May 14th. Again, much appreciation for the info and support.
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Is there any imaging that might help with this differential diagnosis such as the Fiesta MRI or any of the other kinds of imaging that are available. I want this taken care of in one surgery on one side so the Doctor has got to be capable of all of it.
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@JugularEagle - There are no scans that I know of that show the extreme detail that is visible to the human eye during surgery. Usually a CT w/ contrast or a CTA/V or MRA/V will show enough to make a diagnosis of VOO or of internal carotid compression, but as far as I know, it’s only during surgery that the big picture is revealed.
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Would you recommend Nakaji if C1 is involved
Absolutely. He’s the best.
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Did you have C1 shave or straight styloidectomy?
C1 and styloid on the left. The right was scheduled as the same but once he was in the surgical field the plan changed to styloid resection, carotid sheath fasciotomy and lysing of posterior digastric and omo and myo hyoid muscles
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Hi again
Do you know if they infact deal with non dominate side first? Being non dominate means what?
Compression level or symptomatic?
My left side more painful and right side looks
more complex and collateral veins exist there.
Hmmm? 
Hi,
There used to be a theory to do the non dominant side first in case there was surgical damage the dominant side would be preserved. Now they have done enough of these surgeries that that really isn’t an issue. We chose to start on my non-dominant side first because it was more stenosed and we hoped that opening that up would be enough with the small amount of flow that was happening on the right. Unfortunately it wasn’t enough. The veins on the non-dominant side were too small, hence the non-dominant side. When you look at your scans or others scans you can often see that the veins on one side are simply larger than on the other side and handle more drainage. But sometimes if both are similar in size and even not you can start with the side that has more symptoms…perfectly good choice.
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Non dominant means the smaller vessel- quite often people have a smaller vein (also called hypoplastic), and a bigger vein. If the bigger vein has more compression then you’re likely to notice more vascular symptoms, if the smaller one is compressed then it might not make too much of a difference. I didn’t know about all this when I had my CT showing bilateral compression, I had the side which caused me most pain done first, which was also coincidentally the side which was more compressed.
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Makes sense…now I have to look!
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