Question about my upcoming surgery with Dr Hackman for vES


So I have surgery with Dr Hackman in two weeks. He’s removing a remaining stub for my left styloid from my previous surgery and completely removing my right.

For my left side, he’s going to likely just go through my ear. He mentioned that he first goes through the ear and if that doesn’t get the whole thing he goes through the neck as well.

Now for classic eagles this makes sense to me, but for vES, I wonder if just going through the ear isn’t enough if I also want him to visualize the ijv, strip any scar tissue if there is any and untangle it if needed.

Should I mention this to him? Is what I am asking make sense? Is it possible to do the full job just from the ear?

Below is my right styloid for reference.

I also realize that given the size of my styloid there’s a good chance he won’t be able to do it all from the ear, but you never know…

@elijah I should not be talking about surgery since I am still on the never ending waiting list in the Canadian public healthcare system and not had one yet but I assure you, that you are in good hands based on numerous cases that Hackman has done and has been reported here. It is normal to be in anxious state as the date of surgery nears and as protective mechanism, our brains will ruminate and put forward all kind of catastrophic scenarios which in the end might not materialize. Wish you all the luck with the surgery.


Out of curiosity, do you think it’s possible to do the full job just from the ear?

I really do not know. Perhaps you can ask him prior to the surgery. Only he can answer this.

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I definitely will. I know that for most he ends up making a second incision in the neck, but I do know of one case where he did both only through the ears and I think that person needed further work done to free the IJV.

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I had surgery with a UK skull base surgeon, with jugular compression & 4cm styloids he took the styloid back to the skull base with an incision behind my ear- don’t know if this is helpful or not! I guess you could say to Dr Hackman whatever needs doing you’re not too worried about where the incision is or if he needs to do two, as @KoolDude says he is very experienced…
Hopefully some others who’ve had surgery with Dr Hackman will give you some advice!

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Oh, that’s good to hear. So in your opinion, you think it’s possible to visualize and free the IJV all from the ear incision? I guess that’s what I’m trying to figure out, if it’s possible to do the full job from there.

Meaning, did your IJV decompress by the simply removing the styloid, or did your Dr have to also do a little work on your IJV from that incision area?

Weighing in w/ my opinion here… Your right styloid is VERY long. I think you need to directly ask Dr. Hackman the questions you posed in your post i.e. Will he be able to visualize your IJV just going through your ear, & determine if he’s successfully decompressed it, & will he be able to see & remove any scar tissue that has built up, OR would starting w/ a neck incision make more sense because of better visibility& accessibility? You are the patient, & he should do your surgery the way you want it done.

I find it curious that he starts w/ an ear incision (less invasive, I presume, than going through the neck) but then progresses to a neck incision rather than just doing the neck incision to begin with especially in vascular cases where he needs to see if the IJV, ICA decompresses or not. Perhaps, as others have said, the ear incision is adequate?

Dr. Hackman starts with an incision in front of the ear around the parotid gland. He will likely remove the remaining stub that way because it is short. If the styloid is too long - incision length has to be slightly longer than the styloid - he then moves to the neck incision. So, he does not remove anything through the ear - it is in front of the ear, where he can get as close to the styloid as possible. He will know the best way to approach both styloids once he makes the initial incisions. My remaining styloids were 3 and 3.1 cm and not too complicated, so one incision on each side was sufficient. A group member who had surgery with Dr. Hackman before me ended up with incisions around the front of her ears and neck incisions because hers were longer. The CT scans don’t perfectly capture the size of styloids because the ends can be very thin. I had 3 CTs, and radiology reports for all 3 under-estimated styloid length. So, Dr. Hackman has to get in and see them to determine the best was to remove them.


I would mention your concern about the IJV and scar tissue, but not suggest how he approach the surgery. He has an excellent process and is extremely good at it - he will know what is best.


Thank you. I will bring up my concerns but obviously I will leave judgement to Dr Hackman. My suspicion is that for my right side he will anyways need to go through the neck because my styloid is extremely long there. I’d be shocked if he were able to release the entire thing from in front of my ear.

Really happy to hear your seeing positive results from the surgery.

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My incisions were behind the ear, so a different technique then…but it was enough to remove the styloid. The jugular didn’t need inflating afterwards, luckily.