Today I have met my surgeons two of them both ENT but one is senior has extensive experience in skull base surgeries from cancer to trauma. The other one is also ENT surgeon but more on reconstructive surgeries. They team up to do the surgery. They do transcervical surgery with endoscopic removal of the styloid. I am just wondering if you guys are familiar with the endoscopic part. Seems to me they make small incision and the rest is done navigating through the endoscopic device. Usually this method of endoscopic use is extensively employed in interoral approach but I would like to hear if it was used for your surgeries. Secondly, they told me they only monitor the facial nerve but not the other nerves. So I am also wondering how many cranial nerves were being monitored in your surgery. They also tell me that they remove it to skull base though I am bit skeptical since the incision will be small. Finally, these 2 guys did only one Styloidectomy last year and apparently it was success with minor facial issues which is improving.
That’s great to have met your surgical team. Did they mention whether the “endoscopic” means “robotic endoscopic” (i.e. the daVinci robot), or manual like some appendectomy? In general, will you trust them enough to have them operate on you?..
The only information I can help provide is that Dr Axon told me that he monitors the facial and accessory nerves during surgery.
How many styloidectomies have your surgical team performed in total? I hope it’s many since the more experience, the better. It’s good to know that the styloidectomy they performed last year was a success.
I’d like to hope that they do indeed remove to the skull base. This is when it would be more than helpful to be able to see evidence of this through images of prior patients.
I’ll just echo @vdm in asking on whether you feel like you’re happy with what has been explained to you and if you feel you’ll be in safe hands? I think it’s most important to trust your instincts.
@vdm Nope, they did not mention too much about daVinci robot. I am not sure if I trust their experience with Styloidectomy since they only operated on one case so far, other than that they appear to be very experienced in Surgery of the Neck & Skull area. I guess my choice here is limited.
@Dontgiveup When I asked them, they only said, they performed one so far, I really do not know if they even have done it beyond the one they just mentioned. Styloid removal in Canada is rare and mostly done in intraoral for the few cases I have seen here in this site.
Good that Dr. Axon is monitoring at least couple of nerves. Since he has done countless of them, he can perform this with minimal risks to the patient (Another blessing that you should count). We could only wish for Surgeons like Axon here in Canada.
@KoolDude Is there any possibility at all that you could travel for surgery? Would that be an option? It’s absolutely crap that there are so few doctors/surgeons that are able to perform this surgery well.
Yes, I can travel to the states for example but it will be out of pocket. Here, the surgery is covered under our universal healthcare.
@KoolDude yeah, pretty much like the NHS over here, unless you have private health care.
I hope you’re able to travel to get the best care if you’re not satisfied with your current options. The most important thing is to feel like you’re in the right hands and you have confidence in your surgeon.
I’ve heard really great things about Hepworth in Colorado - though not sure if he does C1 shave?
If they’re used to operating in that area, and understand that as much as possible needs to be removed, you should be okay- an experienced skull base surgeon is what you need… The endoscopic part I don’t knw, as others have said the Da Vinci robot is the only other method of surgery I’ve heard of being used. The facial nerve is the nerve most often irritated during surgery so good to monitor that one. It’s difficult because there’s not much choice where you are, it would’ve been nice to have seen someone who’s done more styloidectomies, but an experienced skull base surgeon is a good second choice IMO!
I totally second everything that Jules said. When your choices are very limited, going with a surgeon who is very experienced in the area where your surgery is to be done could outweigh the negatives of lack of experience in the particular type of surgery you’re having. At some point, you need to decide if the potential benefit outweighs the risk. That may come down to a gut feeling. Perhaps the surgeons would be willing to share your contact info w/ the patient on whom they did the previous ES surgery so you could ask some questions of that person.
I would also clarify what endoscopic surgery means i.e. DaVinci Robot or some other method. At least their surgical approach is external & not intraoral.
Thanks @Jules & @Isaiah_40_31, I do not have much choice here in Canada so I might stick with these guys. The endoscopic thing is common and I suspect most of the doctors use it nowadays. That is why you see small incision in the middle of the neck which is far away from the skull base where the styloid originates from. I think they use some kind of endoscope to navigate all the way up to the skull. I just saw transcervical surgery with endoscopic removal of the styloid in the papers I was signing so was wondering if others saw it.
Seems like a tiny opening for an elongated styloid removal wouldn’t be as safe as a larger opening. Perhaps the styloid is removed in pieces via the endoscopic surgery. I know that is often the case even w/ a conventional neck opening as it helps prevent a long piece of bone from banging into or poking nerves & vascular tissues as it’s being extracted. Worth asking about before committing to surgery, I think.
@Isaiah_40_31 I found an interesting study where they removed the styloid through small incision in a number of people. I guess endoscopic transcervical approach is gaining popularity now. Typically, endoscopic assistance was often used in the intraoral approach. I will see. May be it is more efficient way of doing it since the recovery might short and with endoscope they can see things better hence less injury.
Here is one of the images from that study. Look at the incision of this lady after one month. It does look small and may become totally invisible after a year or so.
Study link : Application of surgical navigation in styloidectomy for treating Eagle’s syndrome
This sounds very promising, KoolDude. Surgical techniques are constantly improving & becoming less invasive. The reduced physical trauma helps dramatically reduce recovery time. It would be really fantastic if the external endoscopic surgical approach to ES ends up being very successful & ultimately adopted by ES surgeons as a whole.
Thx for the ongoing education you provide for us!!
Canadians here too researching the cost of styloidectomy outside of Canada. Have you been able to determine the cost of the surgery elsewhere?
Hi Stretchgiraffe,
The two surgeons in the US who have most often done surgery for our Canadian members are Dr. Samji in San Jose, California & Dr. Cognetti in Philadelphia, PA. If your relative has bilateral ES, contacting Dr. Hackman in North Carolina would also be a good option as he will do bilateral surgery all at once where the other two require two surgeries - one for each side.
Getting the surgical cost from the doctors’ offices directly would give you the most current information. A ballpark figure for Dr. Samji is $11-12k per side. I’m not sure about the other two doctors though.
That’s great news. Do you have a date? Endoscopic sounds a good option to me. Totally different area but my husband had a bone spur removed from his shoulder and you couldn’t even see the wound afterwards. If these 2 surgeons have a lot of experience with neck surgery that sounds good. Also much less inflammation and scar tissue potentially afterwards.
@DogLover I will soon know the date as they called me the other day for more info. Since I am away on family vacation, I was not able to communicate with them. I am guessing it will be sooner may be April or May timeframe. My biggest concern is if they did not remove it at the skull base where it is compressing the IJV the most but hoping for the best.
I am at square one again. Yesterday, I have called the hospital to find out where I was in the waiting list for the surgery. I was told that one of the surgeons that was supposed to do my surgery is now on a leave of absence and they are trying figure out who they are going to send his patients to do the surgery. I have done all pre-op work back in Feb 27th and now since it is more than 3 months, that pre-op has expired and I need to do another one on the phone apparently. All I can say is, the Canadian healthcare system is really failing us. First they consider our cases not life-threatening and put you at bottom of the list and doctors can be gone on a leave of absence and you never got to be notified until you call them. To say, I am disappointed is understatement.
I’m so sorry about this. I wish there was something I can do for you. You offer so much insight and support on this group and it just doesn’t feel right that you have to suffer through this due to a faulty medical system. Just feel terrible for you 