Styloidectomy, CSF Leak, Spine, Jaw | All the stuff

Wondering if anyone here has about, or has experienced doing a pledget study?

I am scheduled for a fast approaching styloidectomy. I’ve had a CT Sinus w/ contrast imaging that showed evidence of a CSF leak from sinuses.

I am being asked to schedule a 2 day pledget study to check for a CSF leak prior to the styloid surgery… I believe the doctor would repair the CSF leak at the same time as the styloidectomy. The study sounds pretty painful and involves radiation.

I have a question out to my doctor to see if it would be doable to repair a leak using the less invasive imaging, if the pledget study is necessary.

This is all new to me and sounds pretty scary and painful, hopefully will lead to really good outcomes from where I’m at now.

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Welcome to our forum, @Hello_World! I’m glad you found us. I hadn’t heard of a Pledget Study prior to your question about it. We have a number of members who’ve had other types of testing for CSF leaks & some who had external evidence of a leak i.e. clear fluid running out of nose or down back of throat that tastes metallic. If you have either of those symptoms, it seems the pledget test isn’t necessary since it won’t clarify the source of the leak, only that you have a leak. If you click on the magnifying glass image in the upper right of this page & type in Pledget Study, other posts where it’s mentioned will come up for you to read. Here’s one thread to get you started:

Another important bit of info is that if the cause of the CSF leak isn’t taken care of first, the patch will most likely come off shortly after it’s placed. In cases of ES, our members with CSF leaks seem to all have internal jugular vein compression caused by the styloid sandwiching the IJV between itself & the transverse process of the C-1 vertebra. This causes intracranial hypertension (high blood pressure in the brain) because the deoxygenated blood can’t flow out as fast as the fresh, oxygenated blood flows in through the carotid arteries. If the IJV(s) aren’t decompressed prior to a CSF leak being patched, the IH won’t be remedied & therefore, the

Do you mind sharing the name of the doctor who will be doing your styloidectomy & possible CSF repair?

Dr Hepworth, so in good hands!

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Hi @Isaiah_40_31,

Thanks for the response. Follow ups to help get to a more clear answer around the CSF leak / pledget study & imaging.

  1. Dr. Hepworth is scheduled for the styloidectomy / possible CSF leak repair (s?). Styloidectomy is left sided w/ jugular decompression, and likely removal of scar tissue from previous surgery. At this time not seeing a need for the right styloidectomy due to enough flow, doing the left side should help with flow to both sides in my case. Referrals to Dr. Hui, Dr. Fargen & Dr. Fraser Henderson for possible additional procedures (brain/spine), if the initial surgery with Hepworth isn’t sufficient. Also recent consults with Dr. Lidell (oral surgeon).

  2. Search on this topic seems pretty limited, hard to know if related to my situation so here is more info:

  • I went into the first covid lockdown with a referral to see an ENT for a horrible sinus infection that wasn’t responding to antibiotics (first time w/ bad recurring sinus issues). It was also a requirement to take my tiny children for in person visits during lockdown for their symptoms before vaccines were even available, so had to sit in urgent care rooms for hours catching everything imaginable so the kids could get antibiotics. Came out of lockdown having received no personal medical care for years with a sphenoid sinus infection and meningitis. I am almost positive that about 1.5 years into lockdown (about 1.5 years ago), I developed a sinus CSF leak with the constant dripping nose, sneezing, pressure, severe neurologic symptoms.

  • Unrelated to sinuses, I had an epidural yrs ago - this is when some of the issues with my entire spine started. Could possibly be another CSF source other than sinus?

  • To top it off I had a traumatic injury to my head/neck about a year ago, which naturally made everything worse.

  1. The CT sinus from about 6 months ago did show fluid in the right sphenoid sinus, suspect of a leak from the left sphenoid sinus. 6 months ago was prior to taking Brilinta - I still had massive head pressure that has greatly improved in the past few months. I’ve had previous CTs of sinus and upper cervical spine (every 3 months) after the initial sphenoid infection they eventually showed mostly cleared sinus (some frothy debris in right sphenoid :face_with_diagonal_mouth:). My sinuses aren’t great but I don’t have the dripping anymore, so wondering if that could have healed/partially healed on it’s own w/ blood flowing better to my head. Related to the epidural & spine injury, there could be a CSF leak coming from elsewhere… not sure that Hepworth would repair that leak, so assuming would be a separate surgery. Kind of speculating here.

This pledget study seems invasive w/ lumbar puncture, 2 days of nuclear medicine and I’m assuming a bunch of CT scans for my whole spine, plus the stuff stuck up the nose. Then I’d head right into the styloidectomy/sinus surgery. I don’t want to put my body through more than needed too quickly if not absolutely necessary, and I am more than ready to get the styloidectomy asap. I don’t know enough about the sinus anatomy…from what I have read, some people can get a sinus leak repaired just with the CT sinus imaging and not need to do the pledget study.

Honestly this is all new to me, and obviously not straight forward. I know Brilinta and some other treatments have been helping in the past few months, definitely not better though…so I want to trust the doctors orders.

Oh, I’m also having a medical mouth splint made this month (Dr. Caufield) that I will wear to try and get everything properly aligned (working with imaging from all of these other docs/specialists), which may also help with my whole spine/head/neck, and might not need as aggressive spine surgeries, or another oral surgery.

SO MUCH FUN! If anyone has thoughts on anything related to all of this, help me out. This forum has been useful for gathering insights. Thanks!

*The fact that I am able to type this out is a major win. I stopped being able to look at screens, type/write, speak coherently, lift kids, could barely even walk for large portions of the past few years. Hopeful to be on the right track for a functional life again, the human body and mind is capable of more than we know. Apologies if this isn’t the easiest to follow


First, let me say that I’m really sorry for the huge load you’re carrying being a mom & having many significant health issues. Your COVID era story is pretty horrific, too! All you’re going through is really tough, but you wrote an amazing couple of posts so :partying_face: :partying_face: :partying_face: to the bit of recovery that has allowed that.

I’m so thankful that you’re Dr. Hepworth’s patient. He is wonderful at leaving no stone unturned in the complex cases he sees & has a plethora of other medical specialists to call on when a case is beyond his scope as you’ve experienced.

CSF leaks can heal themselves, however, if you’re having potential symptoms that could be the result of the epidural, then further testing may be mandated. It’s my personal opinion that you should have the styloidectomy & IJV deompression & see how you feel after a few months of recovery. I don’t know much about the sinuses either so can’t offer any advice there, but perhaps getting the blood flow in your brain normalized will help resolve the symptoms “downstream”. I’m not advising you to go against medical advice just sharing what might be possible if you want to avoid something as aggressive as the Pledget Study especially if it’s looking for a potential leak that would have to be repaired by another doctor later on.

I’ve had issues w/ jaw malalignment (TMJ issues since elementary school) & had braces in my late 40s to realign my bite as my jaw was locking opening when I’d yawn. The braces helped resolve the jaw locking, but the orthodontist told me that my jaw joints were pretty shot & realignment wouldn’t be able to repair that. I had terrible jaw joint pain prior to my styloidectomies but since my styloids were removed, my jaws have been pain free. The right side is quite noisy (only I can hear it) when I talk & eat, but at least it doesn’t hurt. I do sleep w/ a night guard (splint) on my lower teeth & a retainer on the top teeth which seems to help keep my jaw happy. I hope the mouth splint helps you with bite alignment & recovery from pain.

When is your surgery? I’ll put it on my calendar & pray for you that day especially.


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I’m sorry, I don’t know enough about the pledget study and your sinus spine issues to be able to offer any insight into what might be the best decision for you, but can pray you make the right decisions…
Just a note about the mouth splint- some members have found that following ES surgery their mouth guards don’t fit right any more some might be something to consider…
Hugs and prayers :hugs: :pray:

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