Please let me know if you have trouble viewing or if you need me to move or get a different image. If you do need a different image please understand I don’t know right from left etc in these scans or what I’m capturing etc… Thank you!
I agree w/ @Jules. I have marked what may be your styloids in the image below. The right one looks long & squiggly but the left one looks like it’s normal length. Please know these are only guesses. None of your other images showed your styloids. I’m sorry I don’t know how to use the 3D slicer programs though a couple have been recommended here i.e. RadiAnt (for PC) & BeeViewer (for Mac). Here is an example of a 3D image of the area I mentioned:
Hello! I’m in the same boat as you and have been trying to learn to read scans the past few months. I just got my scans loaded into Radiant as well. I agree with @Isaiah_40_31 about the SP on the right looking twisted, like a cork-screw shape, or squiggly. Mine is very similar and most of my symptoms are on the right. The left looks “normal” by comparison but not normal as in length or thickness.
I worked for Kaiser Northern California region for years. I hope your experience with Kaiser on the east coast is much better than mine was on the west coast. Like @Isaiah_40_31 mentioned, there is only one doc in the Kaiser system on this coast familiar with ES and he was up to 70-80 cases as of 12/8/23 and still learning what causes patients to be symptomatic post-op (his words). He thinks the many who experience post-op symptoms were vascular cases to begin with and missed. He mentioned inflammation may cause irritation of the carotid sheath, almost like a callous that may need to be stripped to the brain in some cases. He also mentioned the Kaiser surgical team (a neurosurgeon, vascular surgeon, and ENT surgeon) can’t always get all of the styloid process removed due to fear of injuring nerves or surrounding structures and have had to leave portions of the SP behind. Not all this info was given to the patients, however, and some experienced symtoms post-op. Upon a second follow up CT, they saw fragments of the SP or most of the SP still inside and are now seeking revision surgeries with other more experienced ES docs. He said I’d be wise to look outside of Kaiser but would offer no referral. Every referral that goes out is one less case they get to learn from so a part of me grits my teeth at this because I always think the docs should do what is in the best interest of the patient but that is not always the truth. Look for the very honest amongst the bunch not just who can talk the talk. Stay strong.
I appreciate your time, input & word of encouragement. Do you all know whether Elizabeth Guardiani of UMD is any better, especially if it’s a case other than classic? I’m trying to learn is vascular and venous obstruction the same thing?
@Itsanewdawn - There are two versions of vascular ES - the jugular variant & the carotid variant. A quick lesson in blood flow - freshly oxygenated blood enters the brain through the carotid arteries & deoxygenated blood leaves the brain through the jugular veins. The internal jugulars & internal carotids are more significant in this blood flow cycle than the external jugulars & external carotids.
The jugular variant is where the internal jugular vein gets squashed between the styloid process & the C-1 vertebra or is compressed by a nerve, scar tissue, muscle or by some other means, up near the skull base. This causes the blood to back up in the brain which causes high blood pressure in the brain which in turn, can cause a CSF (cerebral spinal fluid) leak as the body tries to reduce the pressure around the brain. The resulting symptoms are migraines, brain fog, visual snow, other visual changes or visual loss, pulsatile tinnitus (hearing your heart beat in your ear), &/or hearing loss, among other things. The jugular variant has recently been called Vascular Outflow Obstruction in the medical world.
The carotid variant is where the internal carotid artery is being poked or compressed by the elongated styloid. In cases of compression, freshly oxygenated blood isn’t able to get into the brain at the rate it needs to. This causes headaches, dizziness/vertigo, fainting spells, visual changes, TIA (transient ischemic attacks i.e. mini strokes) & rarely a full blown stroke. The carotid variant is a bit more serious because of the stroke risk, but we have members who have lived with it for several years before being diagnosed & have not experienced a stroke.
It’s a little more complicated than I made it sound, but that explanation at least gives you an idea of the difference between jugular & carotid variants.
