Sharing what I've learned about IJV decompression surgery (incl. styloidectomy), from Dr. Constantino with skull model. Warning, Images Of Surgery!

I thought that many of you considering IJV decompression surgery would want to see these 2 short videos of Dr. Constantino explaining the decompression surgery. He’s showing the surgery performed by himself and the neurosurgeon Dr. Lo (Dr. Lo performs the IJV decompression and Dr. C the removal of the styloid process and portions of the calcified stylohyoid ligament).

Not everyone with IJV outflow obstruction needs the styloidectomy (classic Eagle Syndrome surgery), e.g., the patient in this Youtube video that many of us have seen, thanks to a past post to our group. This patient has the symptoms of internal jugular vein compression and not ES symptoms:

If you’re shopping around for neurosurgeons to perform your IJV decompression, you might want to discuss the following with your candidate MDs:

-Unlike the surgeon, Dr. Michael T. Lawton, in that Youtube video (posted 2 years ago, so maybe his technique has changed), Dr. Lo, Tobias, and some other neurosurgeons do not tack the spinal accessory nerve away from the IJV regardless of findings (regardless of proximity of the IJV and spinal accessory nerve) prior to the IJV decompression surgery. They keep the spinal accessory nerve freely moving–far more physiologic than a tacked nerve. Per Dr. Lo, with the full decompression surgery, the IJV typically falls posteriorly away from the spinal accessory nerve once the C1 is removed, into the bony defect (the trough) created by the C1 transverse process removal during the surgery.

-About the C1-shave, I don’t know if the drilling instrument used in the Youtube video is one of the latest, safest ones that neurosurgeons like Dr. Lo use. Per Dr. Lo, “we use an ultrasonic harmonic bone removal tool called the Bioventus/Misonix Bone Scalpel but that being said, it’s not the only one that’s safe (I do feel strongly that ultrasonic in this area is much safer than a traditional drill or power tools). Like a Stryker Sonopet would be fine too for example.”


Thanks for sharing that, I just added a warning about images of surgery to your title in case any of our members are squeamish!


Thank you! I made some minor edits to the text too…


Great video clips, @PamelaInNYC. Thank you for sharing them. Interesting to have the surgical explanation done using a skull. That helps a lot! It’s not too much longer until you have your surgery!

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Thank you for remembering my upcoming surgery–4 more weeks.