How much relief would you say you got ?
And did you get your life back ?
I think I may need surgery if it doesn’t get better
For me, it’s been 95% or more relief! I have been very lucky, prayers were answered 
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Dr Cognetti says “On both sides the jugular vein tapers and essentially disappears around the level of the transverse process of C1”. Not sure how serious this is so can anyone offer a comment on my scans please?
Appreciate it!
What are your symptoms like?
Deanm - I have multiple symptoms that fit with ES leading with extreme dizziness, headache, eye issues, facial pain eyes to jaw worse on right side. I have 4.1 cm right site styloid process.
I have similar symptoms without the long styloid but other factors compressing my right jugular .. crazy you have both sides I couldn’t imagine
Do you get any brain fog?
Does anything help you manage at all?
How long have you had it?
Looks like your styloids are thick and long removing them would surely help I pray for you seems pretty straight forward
Are you going to do the surgery ?
The IJV essentially disappearing at C1 means your IJV compression is pretty significant. I can’t say what percent it’s compressed, but at even 60-70% compressed, the IJV doesn’t completely disappear so yours could be >70% compressed which means the blood can only get through the compressed sections of your IJVs in very small amounts at a time.
I could give a better opinion if you could turn your 3D model so we can see it from the side (i.e. a sagittal image).
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Hopefully you’ll get a follow-up appointment with Dr Cognetti to discuss your results, but as @Isaiah_40_31 says, there’s obviously compression of the IJVs at the C1 level, but you’ll need to find out if it’s mainly from the styloids, or whether the C1 process is also compressing them- I can’t tell from the images you’ve posted… If it’s just the styloids then a styloidectomy would hopefully be enough to give the IJVs more space, but it may be that the C1 process is causing the compression too, & a C1 shave might be needed… Hopefully Dr Cognetti will be able to clarify this for you & discuss a surgery plan.
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Isaiah - Cannot seem to get the official sagittal in 3D but I took these from the right with the elongated styloid process. What do you think?
@ESnerves2025 it’s difficult to interpret your imaging because there is no contrast in your IJVs, only your arteries. So it’s hard to see where the compression of the IJVs are occuring without being able to see them. I think our best bet may be the axial view at the level of C1, and the sagittal view showing the styloid and C1. I have uploaded my own imaging of what the axial and sagittal views look like.
@ESnerves2025 - Thank you for doing your best. The images are good, but as @TML noted, your CTA was a true CTA as it doesn’t seem to include your IJVs. Sometimes when a CTA is done, both the IJV & ICA are included. I guess the good news is that your right ICA looks fine which helps eliminate it as a source of your symptoms.
If you can post images like the those TML suggested, we might be able to see your IJV, though I’m not sure due to the lack of contrast.
The contrast was included and technician states: “right styloid process is elongated, 4.1 cm. It does not an appear to compress the right ICA or IJV (not well opacified on this arterial phase study. . .No contact with the right ICA or IJV.”
Most radiologists don’t know much about IJv compression I have learned
It’s often overlooked
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If anyone is curious I talked to a special orthopedic spine surgeon today who said c1 shave will not create more instability or make it any worse
That was his opinion at least
If that’s worth anything to anyone
As long as it doesn’t touch to ligaments or center just the transverse process alone will not affect stability
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@Deanm Doctors don’t seem to agree on this! Good to know another doctors opinion though, thanks for sharing that!
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I saw two spine specialist today at USC and both agree that I don’t have clear instability. They don’t really look at dynamic motion x-rays at all. They referred me to an upright MRI just to be 100% sure but at this point it has to be something Vascular
at least I ruled out needing fusion and the top doctors don’t even consider me a candidate for a fusion at this point I can probably go into some kind of Vascular decompression with confidence that it’s my only real
Option
Thursday I see a vascular neurosurgeon at cedar Sinai
Let’s see what he says
If no help then Peter Costantino or nakaji are my last hopes
Ryan osbourne is good but he only does styloid no c1 shave so let’s see
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Good to have ruled out significant instability, I hope that the vascular neurosurgeon can help, or if not one of the other doctors we know of- let us know how you get on!
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I just sent over my scans to Dr. Nakaji. He doesn’t really do telephone appointments, but they said he will review my scans and then they will advise what for me to do after that.
Anyone have any experience with them
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