Hello, I’m completely confused. I had an appointment with Dr. Constantino who told me my right jugular vein is compressed, but he doesn’t see anything on the left, even though I can touch a bone behind my elbow. He wants to file down my C1 vertebra on the right to improve the left side. Axon tells me I don’t have compression and that it’s fibrosis due to other surgeries, while Aghayev tells me I have compression on both sides.
YIKES!! It is very confusing getting such different opinions from every doctor you’ve consulted.
I think it’s important for you to understand what your imaging shows, & I hope the doctors who are offering you surgery have gone over it with you.
I just went back to look at the pictures you posted & can only find you put up pictures of your left IJV/styloid, so I can’t comment on the situation with your right side but can speculate the reason Dr. Costantino would suggest decompressing that side & not the left. It looks like your left IJV is naturally small so the fact it’s also compressed is less significant than the compression on the right which I’m guessing is a larger vein & would carry the bulk of the blood outflow from your brain. Opening the right would ease the current burden on your left IJV & could conceivably provide you with some decent symptoms relief.
Based on my just seeing the compression in your left IJV, & now knowing Dr. Costantino has suggested decompressing the right, Dr. Aghayev’s opinion that bilateral decompression would be most helpful makes sense.
It seems your decision needs to be whether to have bilateral decompression done in one surgery by Dr. Aghayev or to have unilateral surgery done by Dr. Costantino w/ the potential for a second surgery later for the left side.
@Jordan My personal experience, I have found Dr. Aghayev to be very observant.
It’s so hard when the doctors disagree on diagnosis and treatment, and they’re all trusted and experienced doctors! It’s very hard, Mr Axon’s opinion that scar tissue is causing compression makes sense, but equally to have a chance at resolving symptoms maybe your C1 needs to be trimmed, I guess it boils down to whoever you feel most confident with, and obviously the cost of surgery etc.
Thanks for your reply 
, could you explain more please.
Thank you so much, Isaiah, for your time, it’s truly lovely. What’s holding me back with Dr. Aghayev is that I don’t get the impression he cuts as large a portion of the apophysis as other surgeons. I don’t want to have the surgery anymore; I’ve already had three failed attempts… Thank you so much from the bottom
@Jordan I only have my own experience to go by, but what impressed me was how observant he was with imaging and how open he was discussing what he saw.
I had successful bilateral styloidectomies in December 2025. The surgery improved many of my symptoms, but I have not seen progress with the pressure on the back right side of my head, into my eye, or the nerve pain into the right side of my mouth and face.
I reached out to Dr. Aghayev for a consult to review my imaging because of a previously noted concern at C1. He had my imaging for less than 15 minutes before he called me and pointed out a complete arcuate foramen/ponticulus posticus bridge on the right side. My remaining symptoms correlate very well with that area.
He did not hesitate to address what he saw with me or offer guidance, next steps, and a possible solution. I really respect that in a doctor, especially one who is skilled in their craft.
He also noted degeneration at C7–T1 on CT, which is another area radiologists have had varying opinions on for years.
I would talk to him about your concerns. I have watched quite a few of his videos, and he comes across to me as very open-minded and as someone who values what his patients say. Of course, that is just my personal impression.
@Jordan - The area outlined in the 2nd image you posted looks like your internal jugular vein. The styloid isn’t visible in that image. The IJV appears to only be compressed by the transverse process of C1.
I agree completely w/ what @MGORNEAU said - Have a serious discussion w/ Dr. Aghayev about your concerns that the styloid hasn’t been cut short enough. In come cases it simply can’t be cut back fully to the skull base because of danger to the facial nerve. Even a “skull base” resection often leaves 1mm of styloid behind.
If you watch his discussion about IJV compression, he explains how much of the C1 transverse process which is removed, it doesn’t sound like he’s conservative with this at all, as he talks about how he doesn’t think it causes instability:
A Review Of IJV Compression by Dr Aghayev - General / Research Papers - Living with Eagle
