I met with Dr. Costantino from New York this week and he said he shortens the styloids to normal length, about 2cm. Dr. Osborne from LA removes it as close to the base of the skull as possible.
Is there a difference for symptom relief in the two processes?
Good question. The answer is - it depends on the situation w/ the styloids i.e. are they extra thick, steeply angled, twisted, pointed, or curved? Do they have any outgrowths or “joints” on them that could continue to be irritating to the local nerves? Not all doctors assess the styloids’ physical condition when considering the symptoms they may be causing. Too many look only at how long they are not at their other physical features & problems they can be causing w/o regard to their length.
The fact that Dr. Costantino leaves the styloids at the “normal” styloid length means he’s relying on a C1 shave to decompress the IJVs vs cutting the styloid back beyond the point of compression which is most often shorter than 1", & also helps provide more space for the IJV. This would also potentially allow for less of C1 to be shaved, & in some cases would negate the need for C1 to be shaved.
The short answer to the question is that for some people, cutting the styloids back to their natural length is just fine, but for others, shorter is better. Have you seen 3D pictures of your imaging? It’s very helpful for you to know what your styloids, carotids & jugulars look like as it will help you to have a more informed discussion w/ the doctors you’re considering.
I do not have any jugular or carotid compression. Attached are the photos I have of the 3D reconstruction that Dr. Osborne’s office did, which probably aren’t very helpful. Both my styloids are 5.7cm so very long!
WOW! Your styloids are VERY LONG!! You do have a good amount of space between your styloids & C1 which is excellent!
You really have no need to see Dr. Costantino since he specializes in vES w/ IJV compression. Dr. Hackman UNC Medical Center would be another option for you. He cuts the styloids as close to skull base as safely possible & has helped quite a number of our members. He is also one of the only doctors on our Doctors List who will take out both styloids in one surgery if you feel like you’d like to go that route. Because he’s at a university hospital, they take most medical insurances & the cost would be far less than going with Dr. Osborne.
•Dr. Trevor Hackman, UNC Ear, Nose and Throat Oncology Clinic – in the N.C. Cancer Hospital, 101 Manning Drive, Chapel Hill, NC 27514, (984) 974-6484
@Isaiah_40_31 Thank you for the information! Yes they are long! Dr. C said I won the award for longest so far in 2025. I said I’d rather win the lottery 
I wonder if Dr. Hackman does virtual consultations?
I know Dr. Osborne is expensive. I just felt really comfortable with him and his unique surgical approach.
Sadly, Dr. Hackman does not do virtual consults, but a few of our members have been able to arrange consults to be followed w/in a few days by surgery so did both in one trip to NC.
If you can afford to go to Dr. Osborne, then he is a good choice. Sadly so many who consult w/ him can’t afford his high surgical charges, & since he takes very limited medical insurance plans, most just rely on the information they get from their consult with him to help them decide on another surgeon.
Well done with your award, but I agree that winning the lottery is far more appealing!
We do usually suggest on here that the shorter the styloids are left the better & the most chance of resolving symptoms, although members have had successful surgeries with their styloids shortened rather than being cut back to the skull base. Leaving some styloid can possibly mean there might be re-growth too…Although it’s not always possible to remove as much as the surgeon would like as sometimes the nerves are just too tangled & it’s too risky to remove more!
Good luck with making a decision about the best surgeon for you 
