Since my last post, I have had 2 virtual consultations. In the sagittal view of my CT image, Dr. Osbourne measured the space between my styloid and C1 as 1.3mm (left) and 5.6mm (right) and believes there is enough evidence to perform the surgery on both sides. Dr. Aghayev did the same and measured 1.6mm (left) and 5.4mm (right). Dr. Aghayev also measured the cross-sectional area of my IJV’s in the axial view as 40mm2 narrowing down at the point of most compression to ‘not visible’ (left) and 79mm2 down to 28mm2 (right). He was more certain in his diagnosis and would perform the surgery including C1 shave.
I was wondering afterwards what is a ‘normal’ cross-sectional area of the IJV’s and researched it a bit:
Mean cross sectional area of the right and left IJV were 165±81 and 119±57 mm2, respectively
My CT image is 9 years old which I think is a bit of an issue and I need to try to get a new one. But aside from that, has anyone ever used cross-sectional area of the IJV’s as another piece of information to support a diagnosis? Is my comparison of my values to these studies flawed? Any other things I can do/request to get closer to a more certain diagnosis? Thanks again in advance…any information is helpful at this point.
In addition to IJV research, an important area of research is the styloid-C1 space which fortunately the doctors have measured for you.
Research shows that, on average, a healthy individual has approximately 9mm of space between their styloids and C1. So you only have 1/6-1/7 the space as a healthy individual on your left side and just over 1/2 the space on the right side.
Even if we ignore the IJVs for a second, 1.3mm space between styloid and C1 can pose another issue - head/neck range of motion. When you perform a chin tuck, or look down, the space between the styloid and C1 gets even smaller, and so it can make the IJV compression even worse and could come in direct contact with C1 and limit range of motion. And then you have all of the muscle compensations that would stem from that.
Looks like you have significant compression on your left side! Some doctors like Dr Nakaji want to measure the pressure in IJVs so requests any patients have a CT venogram with pressure gradient manometry, but this is more invasive…
It’s tricky as to be honest, some people have significant compression but aren’t that symptomatic, whereas others have less compression but more symptoms- it can vary depending on whether you have a dominant IJV, & if that’s the one being compressed you could well have more issues, & whether there are collateral veins taking the blood flow away from the brain…so personally I’d be more inclined to go with how symptomatic you are as to whether you have surgery , or is it whether to have the C1 shave as well you’re concerned about?