My CT w/ Contrast

Welp, looks like my C1 TP’s are ‘bullies’! Both pressing on ‘something’ … IJV (?) …
Left side is the styloid… right side styloid is tiny…but do have what appears to be calcified ligament, but so far can’t tell if it is impacting.
Not sure how involved the left styloid is with compression (<<< it would be more involved w compression when I turn head to left?).

Seems to be C1 majority player. (I am only symptomatic on left with neck pain, spasms, nerve issues).

Had to finagle it to get the styloid in the pic.

The styloid is lightly visible.

Both edges of C1 are impacting veins (?) This right styloid is tiny.

No clue if any way to fix w/o shaving/carving a channel, which I know very little about but will look into.

Adding a posterior full view.

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Hopefully others with more anatomical knowledge & skill with reading scans can contribute, but it certainly looks like the compression is coming alot more from the TPs…removing the styloids could give more space, but I think being prepared that you may need these shaving…but hopefully removing the styloids would help with the other symptoms…
There have been a few discussions about C1 TP shave you could read through, & mentions of a couple of doctors who do this.

Yes, thank you. I’m working on getting an image isolating the three components (like Buzz did)… Absolutely will need C1 ‘addressed’ and learning about that.
Appreciate you having a look.

Edit to add… For the CT w contrast, you can change image to ‘Bones B/W’… it is the first function to the right of the ruler.

In this image can clearly see a gap between styloid and vein, with compression by C1…would expect further compression when I turn my head to the left (which I don’t/can’t do).


@Leah - The veins being impacted are the IJVs & it looks like your right IJV is your dominant one. Definitely can see the indent that C-1 is causing in both IJVs.

Is your right styloid/s-h ligament visible in any of the images? What I thought was your right styloid, in retrospect, may be part of your jaw. The left styloid doesn’t look excessively long, but it is very pointed at the tip which can also be a problem.

In view of the fact C-1 is being intimate w/ your IJVs, Dr. Costantino & Dr. Lo would be the pair of docs to see. They’re in NYC. Dr. Costantino does the styloidectomy & Dr. Lo the C-1 shave if needed. Our member @GCD had surgery done by them today so, hopefully, we’ll get to follow his recovery over the coming weeks.


Thank you for confirming the IJV’s.
Yes, see below for right side tiny styloid. As you pointed out with my first images, looks like a portion of calcified ligament below it, but neither appear to be involved in compression.

And thank you, I am in contact with Dr. Constantio’s office and will be getting these scans to them.
And no surprise, the report from the CT said ‘no issues’… It was a bit of pulling teeth to get it ordered… my internist was wonderful, but didn’t get to request a view where I turn my head to the side, as you guys have suggested.

And yes, the left styloid isn’t that long…but with proximity to C1 seems to be a problem. That my C1 is rotated is a big issue I suspect. It is not fixed but prefers that position. Not sure how Dr. Lo will look at that situation; hoping to consult with him about it. I have no clue it my C1 is ‘too big’ for my neck. My neck is tiny… so without other input, I’m at a loss on it.

Have tried every which way to see ‘someone’ … local who can review this in detail. Have a neurosurgeon appt. but soonest I can get is end of July.

It was quite hard to lay flat. Luckily it was quick… but nerves were not happy with it. I look forward to hearing from @gcd when he’s ready to share!


I do have a consult with Kjetil Larsen, MSK Neurology on Thursday. Hoping for enlightenment.


Thanks for identifying it! I do see the calcification you’re talking about. Definitely looks like C-1 is more the culprit for IJV compression on both sides than your styloids. I also agree w/ you that turning your head left could bring your left styloid into closer contact w/ your IJV.

I hope Kjetil Larsen is helpful for you. He’s definitely helped some of our other members w/ their diagnoses.


So while I’ve been focused on vascular compression as it has been my dominant symptom (although the nerves are a close second), am I correct that the Drs don’t identify the nerve issues with the styloids, they just recognize it/they needs to go?

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I agree with @Isaiah_40_31, both IJVs are compressed by C1 and the right one is the dominant IJV. Based on these Images, Styloid is not compressing them, if any, C1 is pushing the IJVs into the Styloid territories. So I agree, C1 is big culprit here.


Thank you as well, I’m assuming styloid comes into play quite quickly when I have any movement to the left. I can traction my head and get my C1 to behave. But it doesn’t stay there unfortunately. I suppose fusion is an option that I will have to entertain. ((

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In reply to your earlier question, I don’t believe doctors pay much attention to which symptoms are caused by which cranial nerves so they don’t really care about the nerves. Their focus is styloid length & sometimes width, & angle/proximity to C-1 if IJVs are compressed. Hopefully they also pay attention to calcification on the stylohyoid ligament. In some cases, the stylomandibular ligament has also calcified, but that’s very rare.

Regarding your comment in your last post about fusion maybe being required later, I would try the C-1 shave first to see if that helps as fusion is a BIG DEAL. I think having fusion on the table as a second choice isn’t wrong though. You could get a referral to Dr. Fraser Henderson in DC for an opinion. He does CCI/AAI evaluations & fusion surgeries. (Dr. Fraser C. Henderson Sr. – Metropolitan Neurosurgery Group). Dr. Hepworth has sent several of our members to him, & at least one has had fusion surgery which has helped her immensely.


Thank you as always for your kind and caring nature to soothe so many of us! It truly is a gift.

Trying my best to understand all of this anatomy. TY on the nerves, I certainly feel them!

And yes, I will absolutely pursue with Dr. Constantino and Dr. Lo…. One step at a time seems wise… and I certainly wonder about the significant amount of spasms I have on the left…seems logical that the styloid has a part to play there.

TY and rest yourself. I’ve taken too much of your time )))


Please don’t ever feel like you’ve taken up too much time. We’re here to help & support. That isn’t always a straight forward path. I’m happy to share my time. :hugs:


Hi @Leah , sorry I can’t answer any of your questions, but I’m wondering-- what was the name of the exam they did on you to produce those images? I’ve had a “CT head with and without contrast”, and a “CT soft tissue neck with contrast”, but I’ve never seen that level of anatomical detail when viewing the imaging that’s been ordered on me! Maybe I’m not clicking the right buttons, so if that’s the trick and you know how to instruct me, please let me know, otherwise let me know the name of the exam performed. Thank you in advance!

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@Kalee182 the images shown above appear to be a 3D rendering of a CT scan. The standard images provided by radiology groups are not 3 dimensional. If the doctor orders a CT venogram or angiogram, that generally includes the 3D rendering. Many members, me included, had to learn how to use a 3D rendering program to actually see our styloids clearly.


Hey there, my apologies had a Dr. appt yesterday and was wiped out. Yes those are from a CT w and wo contrast. I’ll cut and paste what @GCD taught me about reading them. Are you viewing on Radiant software? If not its a quick download… and then there is a 3D button up top.

Use this link to download Radiant. RadiAnt DICOM Viewer | Starting download…

I had a little trouble finding the correct files… with Radiant open your files using the file icon on top left. Takes a bit to upload the file. Select the one with the most images (will be the most detail). Once open, select the 3D icon which is fourth from the right. Then you should see your image in 3D. You can navigate rotating the image with these Icons
Can get a clearer view with this one … select Bones B/W (still shows some vasculature… so not sure what it filters out, but I could see the Styloid better… still showing the Internal Jugular Veins)…

LMK if need additional help )).


@akc lmk if this helps with Radiant viewer.


Yes yes yes :slight_smile: And it will turn the images into 3D which is what I was hoping for (can’t make heads or tails of the slices… keep going up and down and side to side and can’t find what I’m looking for). Thank you SO much for this and the tag to the tutorial.