New CT scan. Not sure what's going on

Finally got some new CT angiograms with a longer venous phase, which I was told I should get after the first CT scan from France which I showed to a doctor in the Us and the Dr. he consulted said to have the venous phase held longer (probably because you can’t see anything coming out of my left jugular vein). The new scans didn’t show much new and the 3D viewer I used (Radiant) wasn’t as good as the one the Dr. did on my last year. However, I don’t know what to make of it. Is the c1 and styloid still compression the right jugular (b/c it’s quite large) or is it squishing the left jugular so much I have no flow out that side so it’s all being shoved out the right side (hence the large flow and even larger carotid sheath hole) but it’s also where most of my pain is–migraines, body pain but also now having more tinnitus and pretty sure I have vagus nerve dysregulation from either the squishing of the carotid sheath or MCAS, CFS, POTS and mold issues, all prior diagnoses which all ring true. I am loathe to get a surgery I don’t know for sure is the cure. I am attempting to attach the pics of the new and old images to see if anyone sees anything I can’t see or has any observations. I had labeled them all correctly and then the program saved them all with different names. They are basically left and right side views with as much skull and jaw removed as I could do on my own. Also a view into the skull to see the different carotid sheath sizes left and right and a view from above of just the c1 and styloid space (with the whole skull removed) to see about the possible compression. Can’t see the jugular on the left but you can on the right.

this is looking down into the c1/styloid space without the skull in the way.

My old images were uploaded before on the forum as was a video Dr. Middleton did with my images that someone put up recently. I don’t want to take up space to load them again.

Your styloids are extremely long, @jteleia. Just having them removed back to the skull base should make a HUGE difference in how you feel. The jugular vein situation is a puzzle, but it does look like the right IJV is sandwiched between the tp of C-1 & the styloid. That & the fact it looks like you don’t have an IJV on your left side could explain the enormous size of your right IJV. Being I’m not a doctor, I’ll have to rely on those who are better at reading CT scans & looking at 3D images to give a more accurate opinion.

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