Nerve protection

Hello all,
I understand the docs monitor the nerves (not sure how…) but haven’t seen how nerves are protected from damage.

And if I ask for most conservative approach which would be leaving ‘enough’ styloid to protect the facial nerve, does anyone know how far down the styloid gets surgeon out of the danger zone (if there is one)?

I need the styloid cut up enough to clear C1 so the max he can take to give me space. And I do realize if I ask for this, there is a chance it can grow back.

If you guys have pondered this and chosen one way or the other and can lmk your thoughts, would greatly appreciate it.


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Dr. Cognetti & Dr. Milligan both leave about 1 cm of styloid which is barely anything. They both have helped relieve ES symptoms for the long term for many of their patients. Dr. Samji says he does skull base removal but from my own experience & that of other who’ve had him do their ES surgeries, he also leaves 1+ cm of styloid but considers that to be skull base removal.

Unfortunately, w/ vascular compression, it seems that sometimes skull base removal is necessary though recently, more of our members w/ IJV compression have found the transverse process(es) of C-1 to be more the culprits than the styloid(s). Being able to determine prior to surgery what the most likely cause of compression is can be helpful to the surgeon as (s)he decides the correct approach to take for surgery. That approach must be flexible because, as you’ve read here, things on the inside are not always as they look from the outside (i.e. on scan images).


They use electrodes (I had a bruise after my first surgery over my eyebrow, they caught a vein nicknamed ‘the vein of sod’ as it’s close to the skin & bleeds quite a bit!), & can monitor nerve activity this way. So as long as the doctor you’re having surgery with does this, they should be able to see how much of the styloid can safely be removed without damaging the nerves. External surgery is safer because it gives the surgeon much more visibility of nerves and blood vessels. I think anatomy varies so much with all of us that the surgeons don’t know exactly what they’ll find until they start operating; one person’s facial nerve could be in a very different position to another’s, it’s very individual.
Usually we advise that members ask the doctors to remove as much as possible, to ensure that they have the best chance at resolving symptoms.