@gramos currently on a business trip. Will get back to you when I can!
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This is wonderful news about Dr. Aghayev, @gramos. It also provides information that @tesla001 needed about Dr. Aghayev. Thank you for your update. Iām glad @LimeZest will get back to you as soon as he can.
Not all patients have bilateral symptoms even w/ bilateral elongated styloids so some opt to have only the symptomatic styloid removed & wait to see if surgery is necessary on the other side. Usually the second styloid will cause symptoms after the first one is gone but sometimes it never does. It is what we call āerring on the side of cautionā.
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Re the calcified ligaments, I think if heāll remove them that would give you the best possible outcome, as we have had members with smaller calcified sections than yours who have had symptoms from themā¦ Not all doctors do bilateral surgery as there can be quite alot more swelling, so some doctors prefer to do two separate surgeries. If you did opt for bilateral, it would be a good idea to ask for steroids to be prescribed to help with that, and to make sure you ice plenty, otherwise some doctors put drains in for the first night after surgery which helps.
Good that heāll do a C1 shave as well though, and he sounds very thorugh.
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I looked at your images, the left styloid process is not too long (about 28 mm), but it reaches the ICA and has slight contact, but does not compress. Maybe it can cause a problem when rotating the head, if you feel it.
It is a great pity that you did not do venography, because you would have had much more information.
I am sending you approximate measurements:
Before you decide on surgery, I advise you to do physical therapy in the meantime, but only relaxing methods for the neck muscles and if you can, isometric exercises for the neck muscles, provided that you do not feel any problems after performing them.
Chiropractic and aggressive treatments for your condition are very dangerous.
It would also be a good idea to do exercises for your upper back, posture and shoulder girdle, as this will help with your bad cervical spine curvature.
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Iāve circled the calcified sections of the stylohyoid ligaments with pink & the styloid w/ green. The calcified stylohyoid ligaments also need to be taken into account as those sections of āboneā can also be abrading nerves & vascular tissues & causing symptoms. The styloid isnāt the whole problem for @gramos.
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Thank you @tesla001 and @Isaiah_40_31 for your help on measurements and labeling.
Yes I am trying some exercises for neck and posture, not sure If I chose the correct ones is there any resource on the forum we could try? Or any video recomandations that worked for you?
@tesla001 No doctors asked about venography, they asked for angioCT for neck only. Maybe I should consider that also and probably a spine CT or MRI.
Looking at these measurements, I just wonder where did Dr.Aghayev saw that my IJV is compressed to 3.5 mm in both sides, I canāt anticipate that, and no I canāt feel any changes when I rotate my neck. Personally I am convinced that most of my problems come from neck issues but so far nothing is working to ease my symptoms. I again had an panic attack symptom associated with neck muscle stiffness, this time louder tinnitus, heat feeling on my spine cord mainly from neck down to the when shoulders end, this lasted about 30 mins before was able to resume sleep again.
@gramos , @vdm has posted different videos in here, not sure which would be the best though:
List of my favourite resources on YouTube to learn anatomy - General - Living with Eagle
There might be some info in this discussion:
Question for those with military/straight neck (loss of cervical lordosis) - General - Living with Eagle
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As for the exercises, @Jules posted the links. It is difficult to know exactly which exercises help, because we are all different regardless of the same diagnoses. It helps to get some exercise, thatās all I can say. You need to enter that world yourself and find out which exercises donāt suit you, and anything that doesnāt bother you, helps.
I looked at your MRI and I donāt see anything that would alarm you that you need to have a spine scan, because your spine is visible on both the CT and MRI scans. If there was something, it would be written in the findings.
How Dr. Aghayev saw the compression of your IJVs, I donāt know, maybe as a surgeon he has his own methods.
With ES, the golden rule is to do a CTA/V. No one referred me, I did it in a private institution.
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Hello @Isaiah_40_31 do you know if someone from forum can help me actually verify the IJV compression that Dr. Aghayev mentioned to me from the existing CTA I have? Really want to avoid doing another examination as I think I have done plenty of them during these 3 months.
Since you already had a CTA that shows IJV compression, you donāt need to get another one done. Can you look through your scans & post images that show your styloid, C1 & veins/arteries in your neck? You can also post a link to any 3D images you have but make sure your personal information has been removed @Henrik, @Jules, or I might be able to show you what Dr. Aghayev saw.
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@Isaiah_40_31 ,
@Gramos posted links to the dicomlibrary of CT, CTA and MRI in his introductory post.
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I canāt see it in any of your images to be honest, Iām sorry, not knowledgeable enoughā¦
Unfortunately, & in spite of help from @LimeZest, I am still not practiced enough at trying to pull 3D images out of dicom library images to see the ES relevant parts of @gramosās scans. Hereās the link to his original post in case someone else wants to take a stab at it:
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Hi Gramos,
Thank you for sharing your history.
I am also male, 33 years, I am living in Africa.
By reading your story I have got some anwers about my the stomac pain I had last week and I stay 2 days at home.
Hope you are feeling better.
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Hi @Babou223
I am feeling a little better now, my stomach symptoms have improved recently. I am following a more vegetarian diet, but I still havenāt decided about surgery.
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@gramos glad that you are feeling better, do you know which kind of food cause stomac pains ? I will try to avoid them.
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I think gluten, dairy and processed foods are a big factor, I try to replace with fruits and vegetables. And for calories I am using mainly potatoes and rice.
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@many thanks for these advice, I will try to apply them. Much appreciated.
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Hey guys, just wanted to give an update and wanted to thank you 
guys for helping me until now.
@Isaiah_40_31 @Jules @tesla001 @Bowser etc
Recently I have more manageable symptoms, they come and go just to remind me that the problem is still there and to not let me get to normality.
Currently I have tinnitus and noticed that sometimes I hear pulsitle tinnitus on left ear, I still have discomfort on intestines especially at night, back of neck or behind ear deep muscle stiffness I guess SP region, I get this weird tingling or itchy tissue feeling on skull base behind neck, I can not refer it as pain, also If I move quickly like getting up I get black vision episodes even though I am on very low dose of beta-blockers.
Wanted to give an update also with second meeting with Dr. Aghayev who this time sent me a measurement of distance between SP and C1 transverse, which according to doctor is very norrow.
These are the measurements sent by Dr:
This is the published paper on which Dr is based:
I figured the IJV and all the Veins are missing from my CTA so I probably need to re-do it so they record Veins as well. Any suggestions? What neck position should they record? I think in my country they only do supine, didnāt hear that they consider anything dynamic.
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Thanks for the link with the research paper, Iāll upload it to the Research Papers category as wellā¦Do you need another CT with contrast if this one shows how narrow the gap is between the styloid & the C1 process? And given that Dr Aghayev feels thereās compression of your IJVs? You said you were concerned about having to have more scans, & I agree that you should consider the radiationā¦But if you do want to still get this done, ask for a CTV, ie itās the same process as when you had your CTA, but they just need to time when they take the images so it shows when the contrast comes through the veins. If they only do supine then obviously you wonāt be able to get the dynamic one done, chin tuck seems to quite often compress the jugular more from what other members have said (although it does depend on the angle of your styloids) so you could tuck your chin down a bit when youāre laying down for the CT 
Thatās just a personal suggestion/ idea though, not a medical one!
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