@Cindyd - I am so sorry for that your doctor wouldn’t do the venogram. It is a very invasive procedure, & he may have declined if he felt there was a possibility of rupturing your IJV due to the engorgement. It would have been nice if he’d suggested that reason vs just naming it a CSF leak & refusing to go through with it.
I had what I thought was very obvious, significant IJV compression between styloid/C1 on my left side but was required to get an angio/venogram to prove it was bad enough to need surgery. The venogram report came back saying the catheter couldn’t pass between the styloid/C1 so that finally made me a surgical candidate. I had some scary issues after the procedure which turned out to be onset of visual migraines for 4-5 days. The surgeon who did the venogram was no help when I talked to him & told him what was going on - actually told me he’d never heard of that happening to someone. I was afraid I was having a stroke w/ each one. I later learned those might have been caused by the contrast & would stop once it was out of my system. Thankfully that was the case for me.
All that is to say that it seems to me your surgeon was erring on the side of caution. Have you had a CTV to take a closer look at your IJVs or an ultrasound to measure the blood flow rate above, at the point of compression & below it? That is also a telling but much less invasive test. Here’s the protocol Dr. Hepworth uses though it’s missing the note that the valsalva manuever is used intermittently during the testing: