Hello! I had my left side styloidectomy about a month and a half ago and have seen great improvement. I would say about 72% improvement in fact. My fitness tracker shows I’ve even gotten more steps in this year compared to last and my extreme debilitating head pressure, sense of doom and headaches have practically resolved. My question is…why does my CT still show severe jugular narrowing? I was completely shocked to see that and I’m totally gaslighting myself now. I did not get a chance to discuss why with my neurosurgeon because my CT results hadn’t posted yet. Anyone else experience this? I suspect there are many factors to consider and of course the surgery still helped…I’d just like some others experience and input.
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Hi and welcome to the site!
I’m glad that you were able to have surgery and that your symptoms have improved, that’s great!
I have to be honest, it’s more common the other way round, that members don’t feel particularly improved but the jugular vein has been decompressed! It could be that there’s still some swelling which shows up as compression, I don’t know, it’s unusual! Unless there was some compression right up close to the skull base which has been relieved, which didn’t show up very well on the CT and that’s enough to help? Very weird!
I presume it is the left side you were viewing on your post-op CT, maybe the radiology team uploaded the wrong CT?!
But good you’re feeling better…
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@Eaglewillland - Welcome to our forum! I’m glad you’ve had your left styloidectomy & have had good results. I agree w/ @Jules that you could still have post op swelling that is causing some compression you see in your left IJV. It’s best to wait 2-4 months after surgery to get follow-up imaging because of the post op swelling. It can also take a number of months for symptoms to more fully reduce/recover - even up to a year or sometimes a bit more. If your other IJV is also compressed, you may need to have it taken care of, too, for the best overall results.
Do you mind sharing who did your surgery?
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Thank you for your response! It struck me as unusual as well! Upon rereading the actual report it does say there’s a segment of severe narrowing and that it reconstitutes at c2-c3 so that leads me to believe that there is still some visible improvement with the compression. It is still a bit alarming to me that it says severe narrowing though. I’m imagining a straw that’s been squished constantly and then finally that weight is removed- the straw still remains squished but liquid(blood) is still better able to pass through. I also have hEDS and remain on blood thinners so those factors may be contributing. In any case, still perplexed!
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Hey thank you for your reply and for the insight about post surgical inflammation. I do hope I only continue to improve. My right side is also compressed but we’ve decided to watch and wait with consideration of my quick and pretty significant improvement. Dr Fargen at wake Forest Baptist is who performed my surgery.
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This is my post op CT report…
Impression
Postsurgical sequela of left styloidectomy with suggestion of persistent severe segmental left internal jugular vein stenosis with small segment of nonopacification favored to occlusion over occlusion, further described above.
Narrative
CT SOFT TISSUE NECK WITH CONTRAST, 6/2/2026 11:53 AM INDICATION: Compression of vein \ I87.1 Compression of vein COMPARISON: 12/11/2024 head and neck CTA, 1/21/2026 angiogram TECHNIQUE: Axial CT images from the skull base to the upper chest were obtained after intravenous administration of iodine-based contrast for the primary purpose of evaluating the soft tissues of the neck. Portions of the brain, face, and cervical spine were also included in the imaging field. Supplemental 2D reformatted images were generated and reviewed as needed. All CT scans at Atrium Health Wake Forest Baptist and Wake Forest Baptist Imaging are performed using radiation dose optimization techniques as appropriate to a performed exam, including but not limited to one or more of the following: automatic exposure control, adjustment of the mA and/or kV according to patient size, use of iterative reconstruction technique. In addition, our institution participates in a radiation dose monitoring program to optimize patient radiation exposure. FINDINGS: Superficial soft tissues: No acute findings. Aerodigestive tract: Mild asymmetric fat stranding of the left parapharyngeal fat, likely postsurgical. The airway is patent. Salivary glands: Normal appearance of the parotid and submandibular glands. Thyroid gland: Normal appearance. Lymph nodes: No enlarged or morphologically suspicious lymph nodes in the neck. Cervical vascular structures: Segmental severe narrowing of a 2.4 cm segment of the left internal jugular vein beginning at the level of the superior aspect of C1 with reconstitution at the level of C2-C3. There is a thin stream of contrast opacification along this segment with a 6 mm segment of nonopacification at the level of C1 (series 602, image 71). Direct comparison to prior is limited secondary to contrast bolus timing on prior CTA. Imaged brain, skull base, and face: No acute findings. Imaged lung apices: No acute findings. Bones: No destructive osseous lesions. Postsurgical changes of left styloidectomy.
In addition to bony compressions, there can also be soft tissues such as vascular, scar, muscle, nerve, fascia, & lymph tissue that cause IJV compression. The evidence of IJV compression is visible in a CT w/ contrast, however, the specific soft tissues causing compression may not be. It would be worthwhile directly asking Dr. Fargen if he checked the length of your IJV i.e. skull base to collar bone for soft tissue or other compressors in addition to the styloid/C1 area compression as that is what’s necessary to provide full IJV decompression in some cases. That said, since you’ve had such good results already & are taking a blood thinner, I agree it’s a wait & see how your recovery moves forward.
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The blood thinners will be helping still then, will be interesting to see what Dr Fargen says about the compression if you’re seeing him again…
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How do doctors assess for soft tissue/other compressors?
Soft tissue compression can show on a CT with contrast, when you can see the compressed blood vessel but not bone doing this. It’s not always possible to tell what soft tissue is causing the compression until they see it in surgery, sometimes it’s in an obvious place like where the digastric muscle would be, but it can be caused by nerves, lymph nodes, scar tissue…
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