you appear to have an engorged left inferior petrosal sinus (yellow arrow). Normally this sinus is very difficult to see on a scan slice.
You have a large prominent bridging vein (pink arrow) connecting your right and left venous systems at the skull base. The presence of this vein is not a problem, the fact that it is so large however does suggest a problem.
The presence of these two extra anomalies caused by your bilateral internal jugular vein compression can explain your excruciating left facial pain.
Because you appear to have right-sided internal jugular vein (IJV) dominance it carries the vast majority of the blood away from your brain. However, you also have a compression of the right IJV at the C1 level. Because the main âhighwayâ is narrowed, blood cannot move down the right side of the neck efficiently. The very large venous bridging channel acts as a cross-over detour, taking that trapped blood from the right venous system and shunting it horizontally across the skull base to the left side.
Normally, shunting blood to the left side would require a clear left internal jugular vein. However, your left IJV has a severe stenosis at the C1 level. Because the blood travelling across the bridging channel hits a second bottleneck the left IJV stenosis at C1, the pressure backs up locally. This is precisely why your left inferior petrosal sinus appears prominently enlarged. It has expanded like a balloon to absorb the high-pressure overflow shunted from the right side and the back pressure from the left IJV stenosis acting as a âreservoirâ.
The left-sided facial pain is due to one or a combination of the following :
Venous pressure. As the left inferior petrosal sinus appears to be engorged (âreservoirâ) and under high pressure at the skull base it can cause a deep, throbbing ache or pressure sensation on that side of the head and face.
Nerve Irritation. This manifests as sharp, shooting, or burning facial pain due to one or a combination of the following :
The engorged inferior petrosal sinus sits directly alongside the trigeminal ganglion in the brain irritating it.
The pressure backing up across large horizontal venous bridging channel connecting the two sides of the venous system causes venous hypertension inside the cavernous sinus, directly irritating the trigeminal branches (V1 and V2) housed inside its walls.
Left jugular foramen bottleneck. The glossopharyngeal nerve (CN IX) and vagus nerve (CN X) run immediately alongside the engorged left inferior petrosal sinus (IPS) left internal jugular vein (IJV), these nerves could possibly be squashed or pinched at this level or further down at C1 (for CN IX : pain radiating to the back of the throat, the base of the tongue, the tonsil area, and deep into the ear ; for CN X : localized pain, âfullnessâ in the throat, intermittent hoarseness, rapid heart fluctuations, nausea/anxiety, gastroparesis, constipation or other gastrointestinal mobility signs.
@Jordan I agree that the right side is compressed on certain images and open on others (compressed at the stenosis open on the other side of it) which could be causing some symptoms. Left side looks diminutive so compressions on the right, even if not severe, could cause problems since you are relying more on the right for circulation.
TRANSLATION:
Thanks, filya, for your replies. You seem really gifted at reading the images; everything you say matches what Iâm experiencing. Yes, I also have the issue you mentioned regarding the tonsils, and I can still feel a piece of bone behind my tonsil. Thanks a lot.
TRANSLATION:
Thanks a lot to you too, Emerald. Seeing Filyaâs opinion makes it hard to choose . Iâm still just as lost, but anyway, thank you both for what youâve doneâitâs really kind of you. Thanks.
First off, if I was you, I would get a professional opinion on your CT with contrast in DICOM format and any MRI scans that you have from someone who is not a surgeon to remove any bias.
Ask them specifically, (once you are recontacted by them to take your medical history to verify the following and any verifications brought up by Filyaâs interpretation :
âCan the radiologist specifically evaluate my left skull base for an enlarged inferior interpetrosal channel and left inferior petrosal sinus engorgement?â
âDoes the raw CT imaging demonstrate that this venous engorgement could physically compressing or altering the path of the cisternal segment of my left trigeminal nerve?â
"Does this scan show evidence of cerebrovenous outflow restriction forcing collateral drainage through the deep petrosal sinus networks?
or
floy.com (around 200 euros) and ask them the same questions.
Romanian universitiesâsuch as Carol Davila are famous for having highly rigorous, âold-schoolâ preclinical years. Romanian medical curriculums dedicate an immense amount of time to human anatomy compared to other western countries. Also a residency in radiology in Romania is considered one of the most competitive and intensive specialties to get into.
Just had to reply about the bits of French coming through â âMerci beaucoupâ! We spent nearly 2 months in France (two trips) for spine surgeries, and enjoyed learning bits of French. Marseille area, by the beach, that was âŠ
Your worsening of pain in the standing position excludes compression of the nerves in the jugular opening(jugular foramen) (otherwise the pain in the lying position would be the same or stronger). So this is a fantastic idea, it is unlikely that the vein compresses the nerves in the jugular opening (jugular foramen). Iâm not ruling it out, but itâs more like a fantastic assumption.
If you look at the compression between the muscle and your root/remainder of the styloid process, and the increased pain in the standing position, then the pain would be only on the left. So this option is also questionable.
more like these options :1) Your swallowing (dysphagia) problems and some pain are related to the hyoid bone /thyroid cartilage (hypertrophied digastric muscles confirm this).
Neck pain may be associated with protrusions of the vertebral discs or TOS
well, some of the pain in the neck (behind the tonsils) is the result of surgery. The pain will decrease over time, but it will be there. Thereâs nothing you can do about it.
@Jordan, There is also Kjetil Larsen from whom some of our members have gotten âunbiasedâ opinions. I donât know what the charge is now, but I think itâs not too outrageous.
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. Merci beaucoup
,
We spent nearly 2 months in France (two trips) for spine surgeries, and enjoyed learning bits of French. Marseille area, by the beach, that was âŠ