@Isaiah_40_31 This is a standard Doppler scan, used to measure velocities. There’s nothing new or extraordinary about it.)))) Some ultrasound machines support the ability to measure the gradient based on velocity calculations. Many ultrasound specialists are aware of this. But the problem remains the same — the accuracy of velocity measurements. ))
First, we need to understand in more detail how this works, and only then can we claim that someone is wrong. His CT scan shows compression — what’s the point of that, even if we manage to confirm IJV compression with Doppler? Measuring the pressure gradient with Doppler is an even more complex and inaccurate method. It’s useless.
Everywhere there are its own challenges, and we’re all human, so it’s not a given that a doctor or an engineer hasn’t made a mistake somewhere.
Not everything is as simple and obvious as it seems at first glance. Diagnosis in medicine involves many complexities and potential errors.
@nemo Nemo, you and your doctors will still have to make a decision.No one here on the forum will make decisions for you. There is a high probability that it will be enough to remove only the styloid process (but I do not guarantee this, since there is a risk of fibrosis, and you have to make a decision and discuss it with surgeons whether they can remove only the styloid process at the root). You can start on the left side (С1 shave or remove muscle/or styloid only ----- you and your doctors will still have to make a decision ) and look at the change in symptoms, but it’s up to you and the surgeon to decide. (I’m not talking about pain, and maybe some of the symptoms are related to nerve innervation.) To address the pain on the right side, remove only the right styloid process down to the root. You can do a CT scan with a turn of the head, and from this, only the styloid process or an additional nerve compresses the veins (but this is indirect evidence and does not give a 100% guarantee). I was only suggesting to rule out additional problems with the arteries. All diagnostics won’t give you a 100% explanation.
I can also give you an example. I know a person who has the two-way compression of two IJVs, 95% on the left and 85-90% on the right, but he has fairly well-developed vertebral veins (and there is a bubble on the vertebral vein) (in the C1 region, and left a narrow jugular opening).His right side is the main pathway for venous drainage (vertebral veins,facial veins,and his right IJV is thicker and has a larger diameter, while the left transverse venous sinus is severely hypoplastic.). When the head was rotated on CT scan, they partially opened. We measured the blood flow several times on the Doppler and it was very good (with correct angle correction. In my case, the volumetric blood flow rate is underestimated by about 30-40% of the average norm). He had periods of crises, tinnitus on the right, spikes in blood pressure, severe dizziness, something like TIA, periods of mild intracranial pressure (which he did not pay attention to, it did not interfere with his life at all). He first performed surgery on the aperture, slightly straightened the vertebral artery, and neurolysis -the compression of the artery nerve (TOS) was removed. After this operation, his crises and severe dizziness disappeared, but the fog in his head increased, he began to suffocate more often, and pressure began in his chest, tinnitus on the right ear remained.
Then he removed the styloid process on the right by oral method, through the mouth (surprisingly, Dr. Tereshchuk removed it at the root). After this operation, all his symptoms remained, nothing changed, and even after almost a year. His only problem is that his tongue on the right side is not working properly (the nerve is damaged). The right IJV is almost completely open, there is no compression.
He hadn’t touched the styloid process on the left yet. He thinks he has a problem with the aperture (because when he click/presses in this area, the state/feelings changes). He has not yet figured out the problem 100%, but surgeons refuse to go into the aperture on the left, where there has already been an operation. That is, he has already had two surgeries, and is planning a third surgical operation
There’s also another acquaintance, also from Russia; she had only the right styloid process removed (external approach surgery), although the compression of the IJV on the right side was insignificant — only 30–40%, and she also had tinnitus in her right ear. But the left IJV was compressed by 80–85%, and there was also an additional pain symptom on the left side — tingling under the shoulder blade. She experienced pain in her face, ear, and neck. The main symptoms that bothered her were dizziness and tinnitus in the right ears, as well as elevated blood pressure. She removed the right styloid process, and nothing changed in her symptoms (apart from the pain), almost a year has passed..
So no one can give you a 100% guarantee.
It’s up to you to decide what to do — stop doing diagnostics, remove only the styloid process, or do as much as possible with C1 and the muscles.
I don’t deny that some of your symptoms may be related to venous compression. But I would like to see measurements of the volumetric flow rate and intracranial pressure. Although one side is partially open, and we may not see significant deviations from the norm.