Styloidectomy or venoplasty first

[Poppy123]

I have been told that although my styloids are not long or calcified the angle is wrong. My surgeon (who is an expert in is area) has suggested a styloidectomy and resection of the c1 processes (not sure what that is) but first the neuro radiologist wants to do a trial venoplasty. Has anybody had experience of this working and solving ES symptoms without having to have the styloidectomy?

[Isaiah_40_31]

Hi Poppy123 -

First let me say that it’s VITAL for you to know why your doctor is suggesting resection of your c1 vertebra in addition to a styloidectomy & why (s)he thinks a venoplasty prior to the styloidectomy/c1 resection might help with your symptoms.

Resection is “surgical removal of part or all of a tissue, structure or organ”. I would assume that resection of the c1 processes would only be partial as the c1 (atlas) & c2 (axis) vertebrae combined are what connect your head to your spine & are the “pivot” points which allow you to maneuver your head into the many positions into which it can move. Obviously, if too much bone is removed from c1, it won’t cooperate properly with c2 which would create new problems for you.

Whether or not venoplasty would be helpful to you depends on which vein(s) the surgeon would be reopening. If it’s a vein or artery being compressed by your styloid process/s-h ligament, then, in my mind (I’m not a doctor), venoplasty would not be a solution as the only “cure” for that problem is getting rid of the styloids/ligaments causing the compression.

It would be good for you to understand what is causing the vascular tissues to be occluded before agreeing to venoplasty. If it’s an internal blockage then venoplasty should help increase blood flow which could reduce or eliminate vascular symptoms you might be attributing to ES. Again, if the blockage is occurring from an external source like the styloids, etc., then removing those would be the solution. If the vascular tissue(s) are being compressed by the styloids & do not re-open after styloid removal (resection) then venoplasty could be considered.

This is only my opinion as I’m not a medical professional, but if I were you, I’d want some answers about the doctor’s reasoning before electing the course (s)he is suggesting.

[Poppy123]

Thank you! Your reply confirms what I have read re the order in which they should be done. Per the CT my right styloid is very close to the bone (C1) but the consultant is not sure if this is causing all my ES type symptoms, My jugular is also compressed in this area. I don’t think I have any vascular symptoms per what I have read on this site, other than high blood pressure. My symptoms ‘appear’ to relate to the assessory, glossopharyngal and vagus nerves, I.e. Pain. I will question the next steps as you suggest before agreeing. Thank you again, this site is amazing!

[Jules]

I totally agree with Isaiah; I had bilateral jugular compression by the styloid processes, & had surgery for that which helped the jugular veins reopen. They haven’t totally sprung back, & I was told by Mr Axon who did the surgery that stenting would be possible to fully reopen them. However, he didn’t advise this as he said the stents could sometimes cause pain, & couldn’t be removed once in. I didn’t feel that it was needed either, I feel tons better than I did. So I don’t know with the venoplasty that’s been suggested for you if it’s the same procedure as I would’ve been offered or not? There could be risks/ side effects from this, & as Isaiah says, it wouldn’t cure the problem either.
There have been discussions about this before; I found one where a US member had successful stenting rather than a styloidectomy, here’s the link:

ES experienced doctor in metro Detroit area?

Not sure of your ES symptoms, so my case may be different. But I can share what's happened to me over the past few weeks in the hope that it could be helpful. As a reminder, I started all of this being diagnosed with bilateral carotid artery dissections in May of 2014. After 3 months on blood thinners, I was pronounced "healed". A year later my dentist commented on my extended styloid processes and that started this journey - I'm so glad he did!!! Dr. Bojrab was great -- impressed with his sty…

He’s not been on the site for a bit but you could try messaging him to see how things are doing?
There have also been a few people who’ve had cervical processes shortened I think, or at least been diagnosed with ES & this, here’s a couple of discussions & a the first one has a research link:

C1 / transverse process juxtaposition to styloid process may be a cause of eagles

Hope that all goes well with the nerve block, and that the tmj stuff can be improved. I think so many of us have multiple issues which complicates what's ES, and what's down to the other things... Your other cervical issues will undoubtedly affect it too, I have a slipped disc C5-C6, and that has improved, but doesn't take much to start playing up again, and have lots of knots which never seem to go completely...

C1 vertebra and styloid ligament surgery

Thank you for your reply! Just had a look through your posts, and you looked great after surgery. Did Dr Taylor or Dr Cognetti perform your surgery? Also, did you have any ear or neck pain prior to surgery? Finally how long did you find you needed to have off work and before you started feeling better. Really appreciate your response. Sending you much blessings x

They might be a little helpful!