@Hellebore Hi, I saw your post about seeing Dr. Jalisi and was curious how things have gone since then. I had tried to get an appointment with him myself last August, but never actually got to see him. I ultimately went out of network.
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Hi @MGORNEAU, I wish I had something new to report. I have a neurology appt in October I’m waiting on before next steps with surgery.
Regarding getting in with Dr jalisi, I had a referal from another ent (who I really liked and guessed eagles right away but admitted it was out of her depth) who reached out to him directly on my behalf. Looking back he seemed to think of ES only under the very classic presentation of it symptoms wise and outright dismissed my concerns about ijv compression. I’m hoping I can get the neurologist to prove this via mri when I see them. He seems like to be a great head and neck surgeon, has done a dozen or so ES surgeries and removes styloids regularly for access to other issues like tunors and suchs. But I’ll def want a second opinion.
Sorry if some of this is redundant. Let me know if you have any questions and I’m happy to answer if able. Have you had surgery alread?? Or are you working towards it?
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@Hellebore - The imaging you want is a CT with contrast or a CTA & CTV. Those are the best to show the styloids, veins & arteries in your neck when ES is in question because the styloids & hyoid bone are also visible in a CTA/CTV. An MRI will show your soft tissues better, but it’s harder to decipher when looking specifically for vascular compressions alongside ES.
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@Hellebore I had bilateral styloidectomies in December 2025 with Dr. Osborne. It resolved some of my symptoms, but not all; the majority of mine were vascular.
Then in August I had another surgery with Dr. Liu for a complete bridged arcuate foramen on the right, along with removal of the right C2 ganglion/root because of horrendous chronic nerve pain. Fingers crossed that works!
I still have residual right IJV compression at C1, so depending on what symptoms remain, I may still need a C1 resection, but fingers crossed I won’t.
I don’t want to overstep, but from what you’re describing it sounds like a second opinion from a neurosurgeon or neurovascular surgeon with vascular Eagle experience could be really helpful.
One crazy thing in my own case: before my styloidectomies I couldn’t do a tandem gait test — heel to toe. Neurology told me there was no way my styloids were causing that. After the styloidectomies, I could do it again, consistently. So can Eagle/vascular compression contribute to neurological symptoms? Based on my own experience, absolutely.
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@Hellebore My follow-up imaging after the Stanford second opinion identified the elongated styloids was a CTA head and neck with contrast, with a venous/CTV protocol added. That was what Dr. Nakaji in AZ required for a consult and what Dr. Liu ordered prior to my surgery.
The CPT code for the study is 70471, but they have to specifically ask for the CTV protocol.
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@Isaiah_40_31 I had a ct with contrast ealier this summer that shows my ijv are compressed but it wasn’t noted in the by the radiologist in the report. But neither were my styloids and those things are looooonng. (Images are at the beginning of this thread). I’m hoping an MRI will show the ijv and nerve compression aspect.
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@Hellebore - You’ll need a FIESTA or CISS MRI to see nerves. They aren’t visible in a standard MRI even w/ contrast.
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I hope you’re most recent surgery brings you relieve so you don’t have to go back for another! 
Definitwly not an over step!! I welcome the advice. Ive looked into dr liu and costantine as they are closest to me. I would love to to get a second opinion from a VES surgeon but unfortunately going out of network isn’t an option for me. I’m not really sure what else to do than work with what’s available even if its not ideal
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@Hellebore - Both Dr. Liu & Dr. Costantino are VES surgeons. Dr. Costantino is an ENT skull based surgeon who operates together w/ Dr. Tobias a neurosurgeon. Dr. Liu is a neurosurgeon who has a lot of skull base surgery experience. They are both excellent choices for your situation.
@Hellebore I can’t speak to Dr. Costantino personally, but I’ve read good things about him. Dr. Liu I can personally vouch for based on my own experience.
Last year I was on an HMO through Harvard Pilgrim, and it caused a lot of problems trying to find someone in-network to address VES. In 2026, the company I work for switched to Anthem, and thankfully they allowed me to choose a PPO if I paid the difference. That opened up my ability to see Dr. Liu; otherwise, I would not have been able to have this last much needed surgery.
I think getting another opinion from Dr. Annino is a good option as well. If you can get support from a specialist that you need someone experienced in VES, you may have an in to still request out of network help from your insurance even if you are on an HMO.
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@MGORNEAU thank you, that’s good advice to see if Dr annino may be able to help push for me to see someone out of network.
Are you in MA? I’m self employed and get insurance through the state health connector. I’m not sure a ppo is even available through there. but open enrolment is coming up and I’ll have to see what my options are. Since I pay for my insurance myself it’s hard to afford better coverage. 
I love having my own business but times like this make me question is it’s really worth it.
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@Hellebore I live in NH. Insurance is definitely expensive, and definitely pro’s and con’s having your own business but working with animals is 
. I just looked at your profile 
I will be praying you can find a PPO that is affordable through the State health connector that is accepted by one of the VES surgeons you want to work with and that you can get a consult with Dr. Annino in the near future and he agrees you need a VES surgeon!
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