Recently, I posted in some groups in an attempt to connect with patients who are also approx 1 month out from decompression surgery, and received some slightly disorienting information from a few patients.
While I don’t have blind faith in what they believe, I wanted to share here in order to maybe gain clarity from others who have a more sophisticated understanding of differing surgical approaches to complex decompression.
The first patient told me that her recent procedure with Dr Liu included “a styloidectomy, C1 shave, and some lymph nodes removed” in addition to what she referred to as a “fasciotomy”.
I had never heard this term before, so asked her to elaborate.
She said that: “Dr. Liu believes, for true full decompression, the fasciotomy is key. All of our muscles were / are tight, stabilizing us, inflamed, freaking out etc. It breaks up the muscle tissue around the vein so it has more room to open up”.
She asked me if my Dr had “decompressed the IJV clearly?” To which I replied that it was visualized to expand after decompression in my procedure notes.
Then she asked if my Dr had “done any scans after the surgery?”. I explained that I’m scheduled for an ultrasound 3 months post but was not “scanned” immediately after surgery.
When I said that I believed my surgeon had probably done something to help with fascia in surgery( I.e. like some a version of a “fasciotomy” but that it might not have been called that), she bluntly replied:
“Hepworth doesn’t do a fasciotomy, only Liu does currently. Liu goes behind the ear. Yours is probably on your neck”. She also shared that she had a CTV “within hours of her procedure” and questioned wether a jugular ultrasound was even an accurate test.
One thing I’ve clarified since by talking to different patient is that it’s not just Dr Liu that does this. Constantino and possibly others do incisions behind the ear and also use the term “fasciotomy” to describe part of the decompression procedures they do.
Anyway, I know that we can’t always rely on other patients to be gentle with us while we are struggling post op.
At best it wasn’t comforting to have another patient imply that the surgery I just had was somehow lacking or insufficient.
At the same time, I empathize with some patients need to feel that they went to the best surgeon or got a better procedure than others as that may be comforting to them on some level. It’s not a competition of course, but life and death scenarios seem to bring out certain characteristics in people.
I take most of what was said with salt, but I would be lying if I wasn’t also a bit concerned about “fascia” now, as silly as that might be. Frankly, I wouldn’t be surprised if fascia isn’t contributing to allot of pain and discomfort I have daily throughout my whole body, so I don’t want to underestimate the stuff!
The procedure I had seems thorough to me and was with a surgeon I respect very much. I had a bilateral C1 shave, styloidectomy, scar tissue/ lymph node removal. The incision was on my neck/ not behind my ear.
Anyway, this is a very long winded way of asking: Do others here know the difference between what some surgeons( Liu, Constantino) are calling a “fasciotomy” versus the fascia work that surgeons like Hepworth do, and is there any merit to the idea that one approach produces a better results? The idea that a procedure behind the ear is automatically superior to one through the neck also seems silly to me, but at the same time, I don’t actually know why surgeons choose one entry point over the other.
Thanks for reading or for any feedback. It just felt better to write something here than to sit alone with these questions. 
Anyway, I agree with you about the fascia thing and that it makes sense hypothetically that anything and everything that was compressing/ interfering with the jugular would have been removed or repositioned during the procedure.
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