You should be able to upload images now; it’s a trust thing until you first post to stop spamming!
We have had quite a few more discussions about whether to have a styloidectomy alone or whether to shave the C1 first, and obviously without seeing your imaging we can’t say (and we’re not doctors either, but sometimes C1 compression is glaringly clear!), so we do suggest that if possible members get more than one opinion. There are a couple of informational videos that some of the vascular ES doctors have put out which are helpful and explain about the benefits of C1 shaving as well:
Jugular Vein Compression: A Detailed Review
Both doctors feel shaving the C1 gives best results, but some members are concerned that this could worsen instability, and @anon30378544 raised the question of whether muscles are detached from the tips of the C1 and if these also destabilise the neck. But on the other hand, we’ve had members who have had just a styloidectomy or a small C1 shave, where this hasn’t been enough & they’ve needed revision surgery, and this is complicated because there can be scar tissue, so not all doctors are keen to do another surgery!
If you have elongated styloids and symptoms of ES, then this should be enough to confirm ES, but in deciding on surgery some doctors like more testing- it’s probably worth waiting until you know who you might want a consultation with before thinking about any more imaging. An ultrasound isn’t invasive but isn’t always accurate, the catheter venogram with manomatry is more invasive and does carry a slight risk…