Hi Jules, that is right for normal contrast CT scan but I think @vdm was asking about Catheter Venogram where they puncture your groan arteries and veins and advance wires all the way to your neck and brain and release the dye there to measure blood flow.
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Really pleased that you have a date for surgery! What has Dr Heim said about doing the styloidectomy and shaving C1; is he planning to do both or just remove the styloid? I agree with what KoolDude says, from what Iāve read of membersā experiences on here, itās difficult to predict whether just removing the styloid is enough; in theory it should make enough space for the vein to decompress, but sometimes this doesnāt happen, & everyoneās anatomy is slightly different.
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Thanks, nice to have you both to learn from 
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Dr. Heim doesnāt do C1. But he removes the Styloid completely! He also does just one side at a time.
He is a Mouth-Jaw-Facial Surgeon who also does plastic surgery, so I hope he is good in not producing to much scar tissue
Iām Germany, he is the only one I know to be interested in this topic, discovering jugular and other symptoms for himself, since he also started with the typical classic Eagle Symptoms.
Heās got an Instagram-Account, itās called āAll about Eagleā.
Maybe all of us should leave comments 
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Wondering somehow, to which degree the JV collapses while standing? Do you know? Since most of my symptoms are in upright position, and that is when the collaterals should compensate, right?
But the other way, I would wake up with a swallen face quite often, and these are the worst days.
Iāve been talking to someone whoās daughter had her styloids removed but unfortunately she still had vascular compression caused by her C1 transverse process. Her jugular vein was apparently somehow attached to C1 itself and she had to have her transverse process removed. She also has cervical instability and her surgeon was of the opinion that removing the transverse process shouldnāt worsen any instability. I guess itās reassuring to hear that opinion from a CCI doctor. But itās still unnerving regardless.
I think itās a relatively new procedure so thereās no data or long term studies to provide evidence that it really has no negative long term effects.
But anyway, her daughter has been improving since the C1 surgery and her instability has not worsened so far (2 months into recovery). So thatās a positive sign.
Another guy I was talking to recently had styloid and C1 surgery to resolve his vascular compression. He posted a before and after 3D CT image which was really interesting. Something odd that happened after surgery was that although the jugular vein was free and no longer compressed, it shrank in size and became really thin all the way down. He believed it was potentially the inflammation from surgery. So the head pressure didnāt alleviate straight away. I reached out to him the other day and he said it was an up and down recovery process but he thinks heās moving in the right direction, which is also reassuring. Maybe it just takes time for the jugular to open up and return to full capacity??
Iād rather not have my C1 transverse processes shaved down to be honest. Thatās why Iām having the Catheter venogram carried out. The amount of vascular compression will determine how vital it is for a C1 shave.
Now Iām nervous about have the catheter venogram 
what is the procedure like? Anything I should mentally prepare for?
Is this test vital to have done?
@Dontgiveup I would not worry as the folks who perform this are trained doctors not technologists. They have contingency plan just in case but it is like a day surgery and they will monitor you about 5 hours after the procedure before they let you go home. You might want to call the hospital to know the procedure details and how you need to prepare for it. They also did blood test to see the clotting factors and kidney function before they schedule this procedure for me.
Regarding C1 shaving & Styloid removal, I have posted a link that talks about the safety and lengthy of hospital stay (My long journey to diagnoses of Jugular Vein Compression by Styloid & C1 - #6 by KoolDude). You are right the swelling takes time to subside and might be the case with that UK patient.
Iām not sure if it is vitalā¦ if you get a good ctv it might be sufficient. Also, you can see your flow void/ the velocitity your blood is circulating with in a certain blood vessel in mri- pics.
Both are less invasive than catheter-angiography.
@Eaglefatigue It really varies from person to person. Based on this study ( Venous collapse regulates intracranial pressure in upright body positions ), it is normal physiology of the Jugular Veins to regulate the ICP so that the pressure of the brain is not negatively impacted by the pull of gravity (hydrostatic pressure). No one knows how upright posture will affect when your Jugulars are already impaired. We can only speculate at this point. Now your symptoms could be that when you are upright, you might be compressing it more or nerves might compressed more depending your neck position which tends to move alot when upright vs supine position. At this point it is just guess game. Here I talked about it here (Question for those with military/straight neck (loss of cervical lordosis) - #10 by KoolDude).
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@KoolDude is right, I was interested in the venogram which is done using a cat going through the groin.
So what exactly is the route of the cathether? Does it pass the heart and then they navigate it to the artery they want to inject the contrast into? Or they use a syringe to inject the contrast into the arteries directly with needles and use the catheter just for some auxiliary function (taking measurements etc.) - I suspect itās not the case as it sounds simply too dangerous and complicated to reach the vertebrobasilar arteries with a needle?
My understanding from this video Angiogram - BRAIN angio procedure video - YouTube that the injection happens through the catheter, after navigating it to the artery leading to the area of interest (in this case, the basilar/vertebral arteries?), and flouroscopy for both navigating and taking the images?
Recently I had an Ultrasound of my carotid arteries and asked about how easy is to compress a jugular vein. The answer was, the jugular veins are extremely easy to compress by anything, it might be easily done just using the ultrasound scannerās head and applying very slight pressure, as healthy veins are very soft, thin-walled and do not have muscular layer inside.
So it seems, the IJV compression might happen many times at many places during the day, just it is typically temporarily (unless one has chronically spasmed muscles in places where the IJV goes through).
Honestly, at this point I might be going a bit insane (given that the surgery works so well in so many cases where people suffer from IJV compression), but I am starting questioning why at one point in our life we suddenly become symptomatic. And I suspect it might be very related to the skullās (cranium) position on the C1 vertebrae. I am not sure how much āleewayā does the cranium have horizontally on top of the C1, but maybe the problem lies within the spasmed occipital muscles that do not allow the cranium to glide forward enough to open up the space between the C1 and the styloids.
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@KoolDude Thanks for your help. And thanks for the link!
Quick question. Do you think jugular compression and IIH can cause POTS? Or maybe that has something to do with vagus nerve compression as well?
Itās funny how it can present differently in people. Like in the video link you posted. Some people have evidence of empty sella, low lying cerebellum tonsils and sometimes there are no clues of high pressure at all on brain scans. All of my brain imaging came back as normal. To be honest, I donāt really trust them to read my imaging correctly and itās worth getting many opinions. I meanā¦they look for chiari in supine 
- Kinda shocked that they donāt acknowledge that gravity plays a part in diagnosing it correctly. So an upright MRI would be necessary to analyse for many potential issues and with the option of putting your head in various positions. The healthcare system is really disappointing and depressing.
Can having jugular compression caused by styloids and C1 cause CSF leaks? Are CSF leaks detected on MRI or catheter venography?
Thanks again for your insight!
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Venous outlet problems can cause CFS leaks for sure. Since the skull is a inflexible container, any kind of pressure or ātoo much fluidā would find a way out somehow. I think it doesnāt matter if itās blood or cfs. If there are predisposed weak spots for a cfs leak, it could be a leak. If not, you might get Chiari. That is my hypothesis. In practice itās often hard to detect a cfs leak, as it often occurs just periodically. Plus, itās mostly secondary to the raised pressure, so once you get rid of the draining problem, the cfs leak will resolve by itself.
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First sign of raised ICP is the raised diameter of the optic nerve sheat, which you can detect on mri. But most radiologists look for picture book like signs like empty sella or chiariā¦
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@vdm Good questions, they advance the wire through the femoral artery and go through the Aorta and bypass the heart to select specific artery (Carotid & Verterbral Arteries) I think Basilar arteryis formed when the 2 Vertebral arteries join if I remember it well. They select each one individually to study that sideās blood flow. For the artery access, they punctured my femoral artery and for Venous access, they punctured my Femoral Vein. There is Chinese saying. A picture is worth thousand words. So the following two videos depict how this is performed. I bet you already watched them in YouTube.
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Yep, that is true. The weak walls of veins. Arteries have thick Walls. Perhaps, the nature designed the arteries so that we do not suffer from potential ischemic stroke every time they are compressed. The do not collapse under the force of gravity either. Veins are collapsible by design, that might not be a bad idea given the regulatory role they play in ICP. Until you do randomized, control study, anything can be concluded but this is unexplored area, you might want to do the study and get your Nobel Prize for establishing causal link with cranium and C1 Position
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I did have partial empty sella and bit enlarged optic sheath with CSF. It was my first clue to the long journey to diagnoses. I did even show this to my Neuro-Ophthalmologist who thought I was joking because he could not see papilledema. So you are right, if you are leaking a bit of CSF through nose or ears, then the pressure never reaches high enough to cause papilledema therefore, they conclude you do not have high ICP.
My 2019 MRI: Enlarged Optic Nerve Sheath With CSF: The tale-tale sign of raised ICP which gave me the clue to searching what caused it.
My 2019 MRI: Partial Empty Sella: Another sign of raised ICP.
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I guess tight occipital muscles would pull the cranium towards c1 or vice versa, so the skull would be pulled to the front. Iād believe itās the military thing changing the position of the upper cervical vertebrae towards the middle ones causing the change in alignment? But otherwise: tight muscles are often weak musclesā¦.