Leftover 1.5cm between arteries and new complications post 5 years after bilateral styloidectomy

Hey everyone! So I had surgery back in 2021 for my Eagles syndrome and they removed over 6 cm of Bones from both sides of my throat and shaved it down at the styloid process as well. Everything got much better I mean before that it was at a point that I didn’t think I’d keep going but after surgery it’s much better and nowhere near the pain I used to have.

Then this past December I fell while holding my one-year-old daughter down some steps on to straight concrete and when I fell I went from four stairs up knees first onto concrete and she was going to hit her head so I had to turn my body so that my baby didn’t hit her head on the concrete and so when I turned I hit the back of my head and neck on the concrete and actually passed out and I have no clue how long I was passed out. My knees are still messed up and I’ve been having weird near fainting or actually fainting spells since then. I used to have these a lot before my Eagle syndrome surgery but I didn’t really correlate them.

In March I decided to ask my surgeon to check and see if I still had bone left over in my throat and to their surprise they looked at this new CT scan with contrast and saw that there was a thin elongated calcification within the soft tissues distal to the styloid process on the right measuring 1.5 cm interposed between the external and internal carotid artery branches. They said that it is in such a sensitive spot that were hesitant to operate on it. I’ve sent him a new message letting him know of my new symptoms to see if that would change anything if he would want to go back in and try to remove it or what he thinks the best option would be.

I also had emergency gallbladder surgery 3 weeks ago and I’m still having extreme pain from that swelling and there is an edema at the incision site but they told me that it would heal itself internally. And a week before that I had a kidney stone which was probably up there with a pain level the eagle syndrome is. And I never thought anything would amount to the eagles syndrome pain.

And for reference my ego syndrome diagnosis came after a bad chiropractor adjustment where they snapped my neck and broke the bone in my throat that they did not see on the scans that they took and it nearly sliced my artery so I’m assuming what happened was the piece that broke off whenever they snapped my neck and it broke is what got stuck in that location in between my arteries.

Also in no way do I blame my surgeon I know that he did his absolute best and their team did as well. And that things like this can happen with this rare disease. And he has been very helpful through everything.

I guess I’m wondering if anyone else has gone through this? Not regrowth but a piece left over in a very sensitive area and if you have gone through surgery again to get that removed or if there are other ways you can navigate the pain, dizziness, fainting spells, vision changes and just all of it. I ended up in the hospital after one of the fainting spells and they were wondering if it was due to undiagnosed POTS or the Eagles Syndrome.

I’m terrified of driving, especially with my now two year old in the car and I just don’t want to risk something happening. I also have severe PTSD from the fall in December. It’s slow motion in my head the moment we tripped on the stairs the moment I’m falling the moment I know she’s going to get hurt so I go knees first to hold her back but then with the momentum of the Fall I know we’re going to keep going so I have to turn my body as fast as I can so she doesn’t hit her head because I was holding her on my chest and I mean it’s like I start crying just thinking about it.

I can’t work, because I never know when it’s going to happen and I’ve also been dealing with extreme nausea which I think is from the gallbladder surgery but the medicine they gave me isn’t helping me. It usually happens when I get up too fast or I turn my head a certain way or when I’m laying down on the bed and I wake up in the morning and I have to just kind of sit there and breathe through it. And I get confused in a way where it’s like that dizzy feeling and you just kind of have to kind of stop for a second and remind yourself that you’re okay and that it’s just going to be a few minutes and then you can get back up because usually in those moments I’m on the floor because I start sweating so bad that I feel like I have to lay down on the floor.

Anyway this was a very long post so if you made it this far thank you and I hope I can get some type of advice from some of the other members here.

Thank you!!

4 Likes

@Asumhannah - WOW! I am so sorry for what happened to you last Dec. I actually had a similar thing happen when I had a baby, except I was roller skating & she was in a stroller. I wasn’t going fast but a slight turn caused the stroller to tip & I fell hard on my bottom & fell back & smacked my head on asphalt in order to keep the stroller upright. Though I ended up with different problems from yours, it’s awful the way that type of scenario keeps replaying in our minds afterward! Did you get a brain scan after you fell, especially because you were unconscious for a while?

YIKES!! that you had a kidney stone just prior to your gallbladder surgery. I’ve heard those are terribly painful. When it rains it pours!! I hope your body starts recovering in earnest from the gall bladder surgery. You could try applying heat to your incision area (20 min every couple of hours if possible) to stimulate circulation as that might help reduce the edema more quickly. There are gel packs available that can be both heated or frozen. Something like that would work well.

It sounds like that small section of calcification may be poking/irritating your ICA & ECA depending on your head & neck positions which is what is causing your fainting/near fainting spells. Irritated carotids can cause the type of symptoms you have which can eventually lead to stroke-like symptoms (TIAs), & a full blown stroke if left untreated.

My non-medical opinion is that you need to get that calcification removed. I’m wondering if the doctor who did your styloidectomies isn’t comfortable doing the surgery, would he refer you to a vascular surgeon who could do it?

We have at least one member who had robotic surgery done by Dr. Hackman years ago. There were some small bone fragments left behind that caused problems so he went back in via manual surgery & removed them. Other than that, I don’t recall anyone having a situation similar to yours. We’ve had a number of members who’ve needed revision styloidectomies due to regrowth or not enough styloid being removed in the first place.

4 Likes

Oh my gosh I’m so sorry to hear that and I hope you are doing okay after that! The PTSD from it is the worst, if I walk down my steps and I’m holding her I hold on so tight and try to walk so carefully.

It has been a wild month. Because of all this I’m also no longer working and I did have a great salary job. But I can’t even do simple things like answer phone calls from customers because I could be on the phone with them and all of a sudden get really lightheaded and that brain fog/confusion feeling again like I used too and then it’s like I forget what the customers are asking and I have to ask again and it was like my brain just wouldn’t work right. I’ve also been saying the wrong words in sentences lately or even saying my own last name wrong.. I said 0 instead of o when spelling my last name. I have NO clue why. Then I told someone they needed to eat their face at lunch, I meant food, but face is what came out. My right eye has also been drooping worse than it used too. I had mentioned it to several people over the last several months but didn’t think anything else really of it.

I’m also thinking it’s messing with my artery or nerves and that is why these symptoms are happening again. I’m terrified of something happening and me having a full on stroke (especially as a single mom when something could happen to me and then my daughter would be alone until someone realized I haven’t responded). My parents check on me often to make sure nothing has happened.

Hoping Dr. Hackman will have some answers on Thursday!

3 Likes

I’m so sorry you’ve lost your job due to the memory & word scrambling symptoms you have. I can only imagine how frustrating that is along w/ the scary dizziness. It’s really great that your folks are checking in on you frequently.

The roller skating incident happened 36 years ago. My daughter will turn 38 this year & is a thriving wife, mom & future doctor. Thankfully, I was the only one injured.

Have you had any brain imaging done to see if anything shows up there that could be causing some of your symptoms? I think that would be an important addition to your neck imaging. I’ve had a couple of traumatic brain injuries from cycling accidents & have some memory issues myself from those, but nothing like what you’re going through.

I assume you had a CT w/ contrast to look for what’s presently going on. Some of the symptoms you’re describing also sound like internal jugular vein compression (IJV). I’m wondering if when you hit your head, something shifted in your neck, & you have that going on as well? Please ask Dr. Hackman to look for that in your imaging on Thursday. IJV compression, if not caused by the styloid/C1 can just appear as flattened spots along your IJVs. That’s because soft tissues can also cause IJV compression i.e. another vein/artery, a nerve, scar tissue, lymph node & even the fascia that surrounds the veins. Most of those things aren’t visible in a CT even with contrast.

If you can get a copy of your most recent imaging & convert it to 3D (or take screen shots of what Dr. Hackman shows you) & post it here, we can also give our non-medical, but experienced-at-looking-at 3D CT images, opinion about what we see as we have noticed things that radiologists & doctors have missed. If you choose to convert the imaging yourself, you can use either radiantviewer.com for PCs or Bee Dicom Viewer App for Macs.

I hope Dr. Hackman thoroughly looks over your CT images with you & has a plan for moving forward that will help resolve your symptoms. :folded_hands: :heart:

4 Likes

i don’t have much advice but I am so sorry you have been through so much!! I hope your next doctors appt can give you better news and that you feel better soon from your surgery!

I am also unable to drive currently (have my little 3.5 year old home with me) and it’s very difficult so I can commiserate.

4 Likes

Thank you! I went back and looked at my scans from December from the fall, and it looks like they did a CT scan of my head but I don’t understand it very well.

Here is the reconstructed CT scan I just worked up based on my most recent CT with contrast from Dr. Hackman in March.

This definitely looks like it is in a bad spot to operate on but also that it could be causing these issues. I took some on my phone as well and am going to upload them here in a second.

1 Like
2 Likes

I also have these from my brain scan I really don’t know what to make of the white dots and open space . That could be normal for all I know

Thank you! :slight_smile:

1 Like

Such intracranial calcifications are found in humans. It’s a pity that you can’t post all the CT/MRI scans on the forum. It is often impossible to understand anything from individual photographs.

@Asumhannah - I’m sorry I can’t help you w/ the brain images as I don’t know much in that area, however, you have some interesting things going on w/ your C1 vertebra & in your neck.

In this image, the section of calcified stylohyoid ligament does not look thin. It’s pretty substantial. I can see how having that banging around on your ICA/ECA could be contributing to the dizziness/fainting you’re experiencing. I would think Dr. Hackman could remove it. Additionally in this image, the greater horns of your hyoid bone look pretty long. They can also come into contact w/ the ICA/ECA &/or common carotid artery & cause the types of symptoms you have. Dr. Hackman does do hyoid bone surgeries so it would be wise to ask him his opinion about the length of your hyoid’s greater horns & if he thinks they may be contacting your carotids.


This image is quite interesting as I can see you have Ponticulus Posticus (arcuate foramen/Kimmerle anomaly) on the left. I can’t see the right as it’s got collateral veins covering it. PP is usually bilateral. In addition, your C1 vertebra is in 2 halves vs being one piece. I suspect this is a developmental anomaly & not that it broke at some point. Ponticulus posticus can cause vascular & nerve problems, but doesn’t always. I’m not sure how significant the gap in your C1 vertebra is, but it should have been visible in your original ES diagnostic scan & since it wasn’t pointed out at that time, it may not be an issue.

The fact you have significant collateral veins on the right side can be an indication of IJV compression as collaterals develop to help a compressed IJV to drain blood from the brain. It’s possible when you hit your head that the right half of your IJV shifted to the right bringing the transverse process into contact w/ the IJV. I had a similar thing happen except my C1 shifted left when I went over the handle bars on my bike, & hit my head on the ground. The C1 shift caused compression of my left IJV.

If nothing else, I’ve given you some things you can discuss w/ Dr. Hackman. Feel free to take the images I annotated with you so you can show him the areas I think are concerning.

4 Likes

I wondered about what was happening at C1 myself. IJV on one side is considerably dominant, the other side is very narrow up at C1 and balloons some down below at bottom of neck. Is it possible the C1 arch missing is allowing for floating C1 up in there?

There is some mild scoliosis in the neck.

4 Likes

I’m sorry that you’re going through all this after having had good results from surgery! You di well to protect your daughter from that fall, what a hero you are!
There’s certainly quite a few possibilities going on with your neck, so it might be worth seeing what Dr Hackman says, and if you’re able to get another opinion to consult one of the other doctors experienced with Vascular ES? Like Dr Cognetti in PA, Dr Costantino in NY or Dr Lui in NJ?

3 Likes

You are seriously - amazing! This is so informative and helpful for me. Coming to this forum to begin with is what helped me with my diagnosis and finding Dr. Hackman. I appreciate everyone in here so much, but especially you! From my very first diagnosis - the anxiety - the new problems - everything you are like the best “nurse” out there. Haha

I knew I had issues with my C1 in the past and I have pretty bad stability problems at times as well, but when you have sooo much going on it’s so hard to figure out what exactly is causing each symptom.. but I’m going to show this to Dr. Hackman and I’m sure he will be able to come up with the best game plan.

Do you happen to know what all the pieces of what looks like broken up bone under/around my hyoid bone is? Because if I push on my throat in the front - things move and pop (so I don’t do this.. haha) but I’ve always found it weird and wondered if it caused any problems.

2 Likes

Yes I’ve got mild scoliosis all the way down thankfully it’s not too bad. I met someone the other day that her back is curved the other direction! It was crazy! I also wonder what all the what looks like floating bones are.

2 Likes

Hopefully Dr. Hackman will have a good game plan to get everything figured out. I might go ahead and send him these photos ahead of time. I would love to consult with a Vascular ES as well but I do not think I could afford it to be honest. I have Medicaid and Financial Assistance through UNC.

3 Likes

Yeah medicaid can be very limiting.. those that need the specialized care the most cant get unless they pay out of pocket. I do suggest you try and get a CTV …a CT Venogram of H & N so you can look at IJVs especially at C1. Its essentially a CT w / contrast but probably a specialized protocol or sequencing.

2 Likes

@Asumhannah - What you’re looking at is likely calcifications of your thyroid cartilage. These are perfectly normal & yours appear to be pretty minimal. Sometimes there is excessive calcification of the thyroid cartilage that interferes w/ the hyoid bone movement which causes “Clicking Larynx Syndrome”. I won’t completely dismiss that the calcification you see below your hyoid as not being part of the problem because the pieces directly below are very close to your hyoid. I’ve added labels to them & updated your image above.

I’ve been puzzling over the struggle you’re having w/ saying the wrong words even when the right ones are in your mind. I’m wondering if that’s a form of post concussion syndrome i.e. related to the “brain bruise” you received when you hit your head vs the possible ICA/ECA compression. You could also ask Dr. Hackman about that & perhaps request a referral to a neurologist.

I believe that Dr. Costantino takes Medicaid, but am not absolutely sure. I’m pretty sure Dr. Cognetti does because he is not in a private practice but works out of Thomas Jefferson Hospital in Philadelphia. I have no idea about Dr. Liu, but asking is free so you could call those offices & ask. :wink:

2 Likes

And I know at this point I’m just sending a bunch of photos but I felt like I can see the jugular compression on these but maybe I’m looking at it wrong. I’m really excited to see him on Thursday and hopeful that he’ll have the best route of care. For the confusion thing in the jumbling my words I have no clue. My mom said that happens to her normally but I was like that doesn’t normally happen to me. But I’m definitely going to let him know about that. He has had me on clonazepam for TMJ and insomnia and then recently I’ve been having more headaches and of course the double vision and I definitely think those are all signs of the jugular compression but I’m not sure if he focuses on that? I remember people discussing before that he doesn’t believe in a certain type of Eagle syndrome but I guess I really won’t know until I talk to him about it more. Regardless of what they want to call it clearly something’s wrong and I just want to get whatever it is figured out and removed.

2 Likes

When you post images please be sure to remove your name & other personal info that’s on them. I edited the ones you just posted to block out your personal info.

Yes, headaches & double vision can be symptoms of IJV compression. In the picture below you can see the gap in your IJV from above. Your right IJV appears quite small & possibly compressed. The left one looks pretty good.

I hope Dr. Hackman is helpful. Since he cuts the styloids at the skull base, he has, in a sense, performed a number of IJV decompression surgeries for people where the compression is mostly being caused by the styloids. For those who have part or most of the compression being caused by the C1 vertebra, further intervention in the form of shaving the TP of C1 down is needed. That’s something Dr. Hackman doesn’t do so a few of his patients who had IJV compression have had to see one of the doctors on our list who specialize in IJV decompression surgeries to get that done.

4 Likes