I know many folks here suffer from what appears to be Autonomic Dysfunction prior to or after ES surgery to remove the bone compression. I found a couple of youtube videos that talk about about Jugular Vein and Disautonomia. The Dr in the video claims to cure some of the causes such as Jugular Valve malfunction. He also mentions the compression can indeed cause disautonomia but only accounts for minority of patients ( ~ 5%) and indicates that if the compression is relieved, they have a good chance of recovering. Overall it is interesting how they treat this jugular-wise even when other disease like MS is present.
Interestingly, he mentions that stenting in the jugular vein puts us at risky of clotting due to the jugular vein staying collapsed in upright position. Apparently, collapsed and/or semi-collapsed jugular vein increases the risk for clotting when stent is present. I thought this has an implication for those of us thinking stenting after surgery since we hardly think about the postural risk of clotting with regards to Jugular vein. Part 2 of the Video talks about this.
That is interesting because some doctors blindly propose stenting the jugular vein without even mentioning the unique physiology of the jugular vein which closes in upright position and opens in supine position and its implication for stents. The current scientific literature suggests that it does this to regulate ICP in health people. So this calls into question why should the stent keep it open in upright position since it wonât collapse easily with stent in it, what is the implication of that in terms of ICP regulation besides the alluded clotting risk.
On another note, I will like to mention that the procedure ( transvascular autonomic modulation , or TVAM) that Dr advocates is also controversial since FDA warning has been issued regarding the risk and efficacy of such a procedure
That was really interesting. Thank you for sharing that. Iâm not sure why anyone would think trying to stent a compressed jugular between c1 and styloid would be a good idea?
It makes no sense. Iâm no doctor but isnât it obvious that youâd want to remove the obstruction? Iâm not sure how a stent would work at all in that scenario.
I donât know how many of my symptoms are due to cervical instability and how many are due to my compressed jugulars.
Can the act of removing the styloid really cause Autonomic Dysfunction? Isnât the point of surgery to resolve this?
@Dontgiveup I agree with you it is not good idea to do that at all since it will be eventually collapsed by the compressing bones. The other reason that really questions the whole stenting of the Jugular Vein is that they naturally close when upright and blood is rerouted to collateral vein along the spine. It reopens when lying down and this is due to normal regulation of Intercranial pressure based on the current medical literature. You do not want to drain the brain too much to cause hypotension i.e lower intercranial pressure. So in theory, stenting will keep the Jugular Vein open even if you are upright which counteracts the natural closure in the upright posture. None one knows what the long term effect of that is. We can only speculate but one which is worthy of asking. I would say given all the potential complications of stenting, it should be the last, very last resort.
I really doubt the styloid removal would cause Autonomic Dysfunction. The only mechanism I can think of is, if the surgeon messes around with the Vagus nerve during the operation too much since it runs along the Jugular Vein. The surgery relieves it only if the Styloid was compressing the Vagus nerve to begin with which is reasonable given the close proximity to the Jugular Vein.
Ahh that makes sense. So if you have jugular compression caused by a styloid, is it likely that given their close proximity, it would most likely be pressing onto the vagus nerve too? Iâm sure mine are, though I donât have any evidence of this.
And I agree with stenting being a last resort.
Could I get your opinion? I donât want to hijack your post, I hope you donât mind.
Would you say that from my CT venogram images, my jugulars are severely compressed or just moderately? Iâm not sure how much compression is required to cause such severe symptoms.
@Dontgiveup you are not hijacking at all. We are here to help each other. I am not doctor nor am I a radiologist but given the 2 axial images, it appears that both Jugular Veins appear to be significantly compressed between the C1 transverse process and Styloid process. I would say enough to warrant catheter angiogram/venogram to assess the blood flow and pressure. Obviously this is not doctorâs opinion but I think you are right to seek help for this.
*I got this pic from the internet to show you how close the Vegus Nerve (black arrow) runs along the Jugular Vein. So it is conceivable that it might get bit compressed too but canât say in your case here since you canât see nerves clearly with CT. MRI sees the soft tissues better. CT is better at bones.
@KoolDude Thank you! I really appreciate your help. I think my vagus nerve must definitely be affected due to my symptoms. It is very close to the jugular vein.
On my CT venogram report it states that on my right side âthere is minor narrowingâ and on my left side âthere is moderate narrowingâ. I mean, Iâm no doctor, but from my own research and using my own eyes, I would say both sides look significantly compressed. Theyâre not extremely closed off thank god, so maybe itâs not extremely severe (though my symptoms say otherwise) but it looks significant to me.
I have significant cervical instability so I know thatâs playing into this as well.
Iâm worried that having my styloids taken out and having my c1 transverse process shaved down will cause more instability - even though Iâve been reassured that since the cervical ligaments wonât be disturbed, it shouldnât worsen my instability. Thereâs not really any long term data or studies to provide that evidence. Just the opinion of surgeons and doctors. Iâm still unsure to be honest.
Iâve been told to get the styloids out first to resolve the jugular compression, and then resolve my instability with regenerative medicine (prolotherapy/prp/stem cells). Iâm just worried about doing something which might make me worse. And I canât handle anything more. But at this point, I donât feel like I have a choice.
@Dontgiveup I think when they do the catheter angiogram/venogram, they can quantify how much compression is coming from the Styloid or C1 or both by asking you to turn your head right, left, front and back. It can be that your Jugular compression might even be worse when the neck is moved to different positions since you have cervical instability. So ask them to do DYNAMIC Angiogram/Venogram if they do not already plan it. I also highly recommend you try SOFT NECK COLLAR/CERVICAL COLLAR. I have seen huge improvement and it is comfortable to wear. In your case, it might even give a temporary relief of the cervical instability issue along with the ease of ES symptoms. I am not advocating any brand, but I found this brand (Velpeau Neck Brace -Foam Cervical Collar) to be both affordable and comfortable to wear.
@vdm yes you can have valve damage but that should be the least of your concerns. You have far greater danger from other injuries such as stroke, vessel dissection, clotting, dye allergyâŚetc. This procedure is invasive and comes with risks although it is typically less than 1%. The most danger is not from veins though. It is from the arteries since they have to inject the dye in the arteries to see the blood follow to the brain and monitor it till it returns through the venous systems to assess the venous outflow. They usually select one side at a time. For example, they will go through left & right carotid artery separately assess blood follow on each side of the Brain and Neck veins. For the posterior brain blood flow assessment, they will inject dye into the vertebral arteries on the right & left. They only need to put wires in the venous system to check the pressure once unlike arteries which they select one at time.
Also keep in mind that Brain Sinuses (Transverse, sigmoid, StraightâŚetc) and Vertebral Venous Plexus are valveless veins unlike Jugular Vein which does have valves. So the brain Sinuses are the ones that you must be concerned about and since they are valveless, I would not worry too much about valve damage. I would worry about artery issues such as stroke. I hard to sign a paper acknowledging all those risks. That was scary as I felt I was signing my life away. Bottom line is, you do cost benefit analysis. If you have typical elongated Styloids, you probably only need regular CT to proceed to surgery but if you have Vascular compression and blood flow issues, this is their gold standard diagnostic procedure before any intervention.
Hi everyone!
Itâs my first post⌠Iâm diagnosed with Jugular Stenosis plus calcified ligaments on both sides. Surgery planned for next Wednesday on the right side, where my cranial nerves seem to be more compressedâŚ
Found Dr. Heim in Bonn, Germany, who apparently has done more then 100 Eagle-surgeries by now.
This topic is super interesting, since I suffer from debilitating fatigue, bradycardiaâs, and other autonomic issues.
@Eaglefatigue First I hope your surgery goes successfully on next Wednesday and relieves your current pain. A little disclaimer: I am not radiologist so my amateur opinion here needs to be verified by a trained radiologist and canât be taken as an expert opinion.
Based on the images you provided, I can safely say that your right Jugular Vein is severely compressed by Styloid process and C1 Transverse Process. Your left Jugular Vein also appears to be compressed by the Styloid process although bit moderately compared to the right one. As far as Jugular Veins are concerned, they come in different sizes/shapes. For example, in my case I have one left dominant Jugular Vein and a naturally narrowed right Jugular Vein. Some folks have bilateral jugular Veins with almost the same size. Some have only one Dominant and the other one is hypoplastic (Stenotic by birth). So in your case, I would need to see Sagittal Images similar to the top 2 ones for the left one to compare whether your left Jugular Vein is the dominant one and your right one is the non-dominant ( Non-Dominant does not mean it is Hypoplastic as I learned it from my Vascular Surgeon).
Having said that, it does appear from the bottom Axial Images, that Left Jugular Vein appears to be bigger than the right one. Whether that is due to the lesser compression on it or not is not entirely clear as I would need more images to compare. I can also see that your collateral veins appear to be more prominent on right side than on the left confirming that severe compression on the right side. See the images below (Red Arrows pointing the opacified collateral Veins). Collateral Veins typically drain the brain when upright and Jugulars do it when lying down so since you did the CT scan on lying down, it can only mean that your Jugulars are impaired and forces the blood on on alternate path (Collateral Veins).
Thank you so much! Donât need to be a radiologist to be talented in reading those pics! Great!!
First pic is right side, second left.
Super, you figured out collateral flow!
Reminds me of a video you posted once. There was a young person with quadriapresis due to collateral outflow in vertebral region.
Besides brain fog and fatigue, I have postural issues, such as ataxia, arm weakness and tremors while upright. Also experienced periodic low- frequency hearing loss, which mostly is due to vascular impairment in the arteria Labyrinthywhich actually origins from the vertebral arteries. So still wondering if this could be explained by generally increased pressure or collapse/ hydros of the capillaries? Or is a Vertebral Artery problem? What would be your guess?
Well, typically in the sagittal images that face opposite directions since the 2 images were facing in he same direction, I thought they were only left side or right side but not both. If that is case then, they appear to be of the same size more or less. You just have a long narrowed segment on the right side which could be due to muscle compression in addition to the C1 & the styloid.
Since the circulatory system is interconnected, you are right to assume that any compression could potentially have cascading effect on other vessels. So all these systems can be potentially affected. I do have Severe bilateral hearing loss on the high frequencies. For example, Nearly half of the people suffering from Jugular compression have hearing loss. The number is even higher than 50% for folks that have bilateral compression of both jugular Veins which you and I fall according the studies below. So if you have venous congestion, all kind of weird symptoms from tremor to ataxia, to weakness and stiffness of the muscles are too common. I hypothesize that this has to do with congestion of the blood in the higher upper cord affecting the spinal code and potentially cerebellum circulation as well.
In addition to tinnitus, hearing impairment or dizziness were reported in about Âź of patients, suggesting also blood flow circulatory disturbances in auditory-related structures - https://atm.amegroups.com/article/view/65337/html#B14
3.2. Clinical features
Prominent clinical symptoms of cervical spondylotic IJV compression syndrome in the present study were as follows: head noise (33/46, 71.7%), tinnitus (32/46, 69.6%), insomnia (31/46, 67.4%), dizziness (25/46, 54.3%), hearing impairment (22/46, 47.8%), headache (18/46, 39.1%), visual impairment (16/46, 34.8%), dry eyes (16/46, 34.8%), uncomfortable neck (14/46, 30.4%), vertigo (9/46, 19.6%), anxiety or depression (9/46, 19.6%), memory deterioration (5/46, 10.9%), and nausea or vomiting (4/46, 8.7%). Other atypical symptoms included head numbness, palpitation, fainting, and dyspnea, each of which occurred in only one patient. The median number of manifestations was 5 (IQR, 4â6) for the involved patients. Cervical spondylotic internal jugular venous compression syndrome - PMC
Thank you so much for your support and knowledge! This forum is great!
Would you say, it is enough to remove the Styloid and leave C1 as it is? Are there differences in the outcomes after surgeries between having just the Styloid removed and having also C1 shaved off?
Know what you mean with the Sagittarius picturesâŚ
This is the one I struggle with daily as I, myself, am being considered for Styloidectomy only here in Canada when I have both C1 & Styloid compression. I think there are no good studies that I know of out there comparing the outcome of the removal of the Styloid alone versus shaving C1 & Removal of the Styloid. That would have given us a quantified mechanism which could make us choose better. However, in the absence of that, we need to look at data (anecdotal - since it is not scientific) here in this site and how people responded to previous operations. Majority of the folks here who had operation went through Styloidectomy despite the fact that some had C1 involvement and most reported significant improvement of symptoms, more on the folks that had Styloid compression alone. There are few who did not improve since they had C1 involvement or due to partial Styloid removal as opposed to complete removal of the Styloid. I can also think of one individual that had C1 shaved but not removal of the Styloid and I believe symptoms persist even got worse. So based on this observation, I tend to believe that Styloid removal alone has higher percentage of relieving the ES symptoms although that depends on how much compression was coming from the Styloid to begin with.
Secondly, I think the outcomes is based on individual compression type. In your case, I believe, at least a partial improvement is likely assuming 50/50 compression ratio on the right side. In addition, let us say, you had muscles compression opened up a bit and that relieves more compression so overall, you have higher chance of having ~ 50-60% relief of the compression which is realistic in this case. Now, your left side is different based on the images your provided. It appears to be mainly compressed by the Styloid and I expect more than > 70% improvement. Keep in mind that there is reason why Surgeons do not do C1 shaving. It is risky as it is involved drilling the bone and removal/relocating of muscle tissues and nerves. Not to mention, since the Vertebrae Arteries pass through the C1, there is chance they can mess it up and cause even bigger problem than Vein Compression since they supply blood to the back of the brain. So they avoid taking that risk and settle on Styloidectomy as it is much safer procedure to do. I think we had someone from UK that had it recently if I recall correctly but it is rare to have both removal. So I would say, have the Styloid removal on both sides. Even if the right side remained 50% open, the left side can compensate for it once you have the Styloid removal from the left.
wth happened to me?!
