There does seem to be quite a difference with head rotation, I don’t really know much about the pressure gradients, hopefully others can comment on that!
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It does seems that way and I hope it is lol - normally people want to see everything is normal but us with ES know better unfortunately. @Jules
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@Emmaann Your overall pressures at the SSS is at the upper end of normal, the change from 13 to 20 with head extension is consistent with IJV stenosis as is the right jugular to sigmoid sinus gradient of 8. The left gradient of 5 is below the commonly used gradient of 8 or more and the more recently proposed 6 or more. Good luck!
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Thanks @Chrickychricky , I thought you’d know about the pressure gradients, but didn’t want to tag you in because of your hip surgery , didn’t want to harass you! 
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@Chrickychricky thank you!!! I really hope this means surgery for me.
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Haha, thanks @Jules. 2 days to go and I’m trying to keep my mind busy!
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@Chrickychricky good luck!!
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Much appreciated!
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I’m interested to know what Dr. Liu says, because my IJV compression is not caused by my styloids. I saw Dr. Costantino who pushed surgery and Dr Cognetti who said surgery wouldn’t help. My Neurosurgeon, who found the compression on an Angiogram, originally did not recommend surgery. Cognetti’s told me that I probably had this my entire adult life- the compression is at the C1. The veins in the back of my neck compensate, so I don’t have high pressure readings- like you it depends on head position.
Let me know, because I’m in NJ and might want to see Dr. Liu.
Thanks
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@Johnny99 I would definitely see what Dr. Liu has to say! He’s so knowledgeable and skilled. I think it’s totally worth it to see him. I will keep you posted post sugery and let you know what he says he found and did and also what he says at my pre op appointment. I don’t have my surgery date yet but it will be in July.
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@Johnny99 - I’m sorry that Dr. Cognetti said surgery wouldn’t help you. I agree w/ Dr. Costantino who’s had a lot more experience w/ IJV decompression surgeries than Dr. Cognetti has.
Just because you don’t have high pressure at the point of compression in your IJVs doesn’t mean surgery won’t help & that they aren’t causing your symptoms. The fact that you have significant collateral veins at the base of your skull is an indicator that your IJVs aren’t working properly & need to be opened up. Collateral veins themselves can cause significant skull base pain at the back of the neck. Your body knows that the outflow of blood from your brain should be coming through your IJVs not through collaterals, I think you’d feel much better once the compression problem is fixed.
IJV compression can be caused by soft tissues as well as C1/styloids so it may be yours is from another vein or artery, scar tissue, lymph node, muscle, or fascia all of which can be taken care of during surgery.
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I agree with @Isaiah_40_31 , obviously the collateral veins are compensating for now, but there could well come a point where they don’t any more, we have seen that on here…
Good to see what Dr Lui says …
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