I had a prolapsed disc C5-C6, when that happened was when the IJV compression symptoms became noticeable, whether it shifted structures a little in my neck I’m not sure…so I don’t know if that’s contributed at all to things for you? Interesting what Dr Osborne said about the styloids being different to how they appear in imaging, members have often said that their styloids are longer than they appear in the CT when they have them removed, because of the slices used for CT imaging.
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@wade - Good work w/ the images. They’re nice & clear. Your styloids/calcified s-h ligaments definitely look long whether or not they are solid there’s enough extra calcification in your neck to be causing problems.
I had an MRV looking for IJV compression & the radiology report said there might be some slight compression of my right IJV. A CTA showed significant compression of my left IJV but the report said there was none. Radiology reports aren’t always accurate. It took seeing my CTA & MRV in 3D for me to realize the true story.
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Hi @Isaiah_40_31 , I decided to spend some time looking at my MRI and MRA data wondering if there was anything left out of the report that might be of consequence. Combing through the MRI data is a little more of a challenge than a CBCT. However, looking at this set I was surprised to see something that looks distinctly like it’s under compression. I’m not sure if this is my jugular (right side) in the images below, but what ever it is it definitely looks like it’s getting pinched up against my C1. Am I reading this image correctly?
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@wade - Good job sleuthing that out! It sure does look like your IJV is being squashed.
In retrospect, you can kind of see it here, too:
Just had my second consult with Dr. Osborne. He reviewed my MRI and MRA scans and didn’t see anything else that he thought could be causing my symptoms. I did ask him about the jugular vein. He said that he did see that in the imagery, but didn’t feel it was that big of a concern. I had my annual physical this morning and showed my doctor the image; he didn’t feel it was much of problem either. This has left me scratching my head a little. Is jugular compression really that benign?
I told Dr. Osborne I wanted to get the ball rolling on the surgery. I still feel a little on the fence about it, but I also feel like I’ve exhausted every other potential cause and investigation method. It seems like no one is ever 100% certain about this procedure. All we can really do is have faith. About a year ago I was ready to give up. But then I decided to pursue one more potential cause which lead me down a series of steps to where I am now. So I feel like I’m approaching this not from a place of desperation, but rather from a series of logical and rational decisions. I know the procedure has its share of risks, but I also know this condition will not improve and could even get worse without taking any action.
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The best I can tell you re: the IJV compression is that perhaps it appears more severe in the imaging than it actually is. If you don’t have symptoms of IJV compression i.e. migraines, visual changes (snow/distortion), pulsatile tinnitus, brain fog, etc, it may be that the compressed area is less severe than it looks, & you’re not being traumatically affected by it. I was told I didn’t have any compression after an MRV & CTA when I did. It took having an angio/venogram to prove it was bad enough to warrant decompression surgery.
If you’re concerned that your IJV could be a problem, you can schedule a consult with Dr. Nakaji in Scottsdale, AZ, or Dr. Damrose in Palo Alto, CA. Both do IJV decompressions & styloidectomies. Dr. Nakaji will require that you have a venogram before he’ll do surgery for you, but I don’t know about Dr. Damrose.
•Dr. Peter Nakaji, https://www.scottsdaleclinic.com
Scottsdale Neurosurgery Specialists - 602-313-7772
•Dr. Edward Joseph Damrose, 801 Welch Rd, Palo Alto, CA 1-650-723-5281 Edward J. Damrose, MD, FACS | Stanford Health Care
The other option is to trust Dr. Osborne & have your styloidectomy(ies) w/ him & see how you’re doing several months after surgery. Sometimes just shortening the styloid(s) is enough to give the IJVs the space they need to open more fully.
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RE ijv compression: I showed my ENT my IJV compression between my styloids and C1 he said that’s a natural tapering point of the IJV in people. I think what most ENTs don’t really look fully into is the degree of tapering or pinching. Research shows that the space between styloid and C1 in healthy population is around 9mm. My spacing is 4.5mm on one side and 3.5mm on the other - so almost 1/2 and 1/3 the space that healthy individuals have. I don’t think ENTs or even radiologists are trained to really assess the spacing through an objective process. My ENT eyeballed it and said it was tapered but fine.
Even if it’s a natural tapering point, I still think it’s nonsense to not treat it. Can cause no problems in one person but misery in another. If a patient is presenting with a bunch of symptoms that align with intercranial hypertension, and no data has ruled in any other condition, than I don’t see the resistance by doctors to treat the IJV compression. Last summer I went to the dentist and discovered I had SIX cavities. Never went because I never had any dental pain. Do we not treat someone else’s cavities who is experiencing pain, just because I didn’t have pain? I wish doctors thought of IJV compression this way.
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I do think that the degree of narrowing vs symptoms doesn’t always seem to align, we’ve had members who are bed bound but the compression doesn’t seem as bad as others’ are. It does depend on whether you have a dominant IJV & if that’s the one more severely compressed the symptoms will be worse, plus some people develop good collateral veins which carry the load for a while… It sounds as if you’ve weighed the pros & cons of surgery well & made a sensible decision 
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Hi @Jules , you mentioned that the collateral veins can sometimes carry the load for a while. Is there a point in which they kind of just give out? Or become too overwhelmed?
I am just wondering because it seems like I must have been managing for a good while, but the last 1.5/2 years, and then especially the last 6 months, I’ve been feeling especially bad. One of my reports said: chronic occlusion of the left internal jugular vein at the level of the jugular bulb with reconstitution via collaterals at the level of C5.
I’m wondering if maybe the collaterals are struggling more recently for some reason and that could be contributing to my symptoms gradually increasing?
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@Kit_Cat I think it’s not that the collaterals fail but rather the brain is trying to compensate with the reduced circulation and then reaches a point where it just doesn’t compensate well anymore. And the body isn’t able to create collaterals fast enough to keep up with the need.
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As @Chrickychricky said! Somebody on here (I’m sorry I can’t remember who!) said Dr Hepworth told them that the body/ brain copes for a while until all of a sudden it doesn’t…
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@Jules @Chrickychricky That makes sense! I think I am gradually heading in that direction. It’s fascinating that the body tries to figure out ways to compensate but I can see how overtime it would just get burnt out.
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@Kit_Cat - I’m sorry you’re feeling worse. I hope your appt. w/ Dr. Nakaji helps you clarify which surgeon is the right one for you.
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So I recently started to get a few new symptoms, or recently experiencing some older symptoms that had stopped for a while. Over the last couple of days I started to experience some nausea without any stomach pain or illness.
I’ve also had what I can only describe as similar to vertigo. I didn’t have any spinning vision or anything like that, just a general feeling of being unstable.
I also started to get a weird nervy feeling in my forehead above my brow line. It’s kind of like a tingling burning and pressure feeling. I experienced this about a year ago, but it went away.
Then this morning I started to get a tingling sensation in my tongue on the right side near the back of my throat.
I just contacted Dr. Osborne about scheduling my surgery. I’ve been somewhat apprehensive. I’ve seen a video or two about cranial cervical instability and how it can have similar symptoms and removing the styloid can create more instability. I don’t know whether to believe this or not.
The two things that make me fairly confident my symptoms are due to the calcified styloid-hyoid ligaments are the tongue symptoms. I can activate or modulate my somatic tinnitus by sticking my tongue out, and the tingling sensation I just recently started to feel in my tongue. I can’t imagine either of those being related to instability of cervical spine.
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@wade - ES symptoms come & go & then come back sometimes worse than initially & sometimes they bring some new “friends” with them. It’s not unusual that symptoms you had previously have returned. The nervy feeling in your forehead is likely from your facial or trigeminal nerve, both of which are commonly irritated by ES. Nausea can be from your vagus nerve which is also commonly irritated by ES. Tingly/burning feelings in tongue & throat are often due to glossopharyngeal nerve irritation by the styloids, another nerve elongated styloids often tangles with.
Because your symptoms are predominantly nerve related, it’s my non-medical opinion they’re most likely being caused by your styloids. CCI usually has vascular symptoms associated with it along w/ the nervy ones. With the exception of your recent vertigo, which can be caused by the trigeminal nerve &/or nerves in the inner ears being affected by ES, & not always by vascular compression or irritation, your symptoms point strongly to your styloids as the source based on my experience on this forum.
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I get a sort of burning/ pressure sensation just above my eyebrow, as @Isaiah_40_31 says that could well be the Trigeminal or Facial nerve, & nausea with the vagus nerve can happen. I had a constant off-balance feeling as well as occasional full blown awful dizziness when I had vascular symptoms. The tongue symptom does sound more likely to be ES rather than CCI as you said…
The CCI issue is cropping up regularly , and whether ES surgery will make it worse, but we don’t know, some feel it has got worse after surgery, others don’t. I guess all you can do is discuss that with Dr Osborne. Let us know if you do decide to go for it, it doesn’t sound as if he has that long a waiting list?
Did you read @vcp02 's discussion, here’s a link:
Post Op- Dr Ryan Osborne- Current recovery-WHAT I HAVE LEARNED*** - Welcome / New User Help - Living with Eagle
You might find it helpful to read about someone’s post-op journey with Dr Osborne.
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Thanks @Isaiah_40_31 and @Jules! I appreciate all of your feedback. I did have a DMX at Dr. Hauser’s office. He did note a little bit of overhang when I performed a lateral rotation to the right side. There was no overhang on the left. He didn’t note anything about flexion or extension. I agree with you and don’t think CCI is really contributing to my symptoms.
The fact that I experience symptoms on both sides of my head and face, and that I have bilaterial ligament calcification is the real evidence for me. I contacted Dr. Osborne’s coordinator this morning. The first opening for the procedure is the week of August 19th. I don’t have a confirmed surgery date yet, but I’m going to try and get it scheduled today.
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I just had my surgery the 25th and 30th, I can assure you, you are in wonderful hands. Please know the end of the road is in sight. Please check out my most recent post. I am open to questions you may have. 
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@wade - Please let us know your surgery date once you have one. I’m glad you’re proceeding with scheduling as I think getting your styloids shortened will help reduce your symptoms a lot.
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I’m so glad both your surgeries are behind you, @vcp02! May your healing go smoothly & faster than expected. 
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