# Styloidectomy vs venous stenting

**URL:** <https://forum.livingwitheagle.org/t/styloidectomy-vs-venous-stenting/21221>\
**Category:** General\
**Created:** [November 11, 2025, 1:44am UTC](https://forum.livingwitheagle.org/t/styloidectomy-vs-venous-stenting/21221 "2025-11-11T01:44:38Z")\
**Posts on this page:** 1\
**Showing post:** 13

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**Author:** ![BirdsOfSore](https://avatars.discourse-cdn.com/v4/letter/b/8491ac/32.png) [@BirdsOfSore](https://forum.livingwitheagle.org/u/BirdsOfSore)\
**Post date:** [February 6, 2026, 6:14am UTC](https://forum.livingwitheagle.org/t/styloidectomy-vs-venous-stenting/21221/13 "2026-02-06T06:14:19Z")

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Sorry I’m a bit late but here is a summary of my visit with Dr. Hepworth.

Assessment and Plan  
The following list includes any diagnoses that were discussed at your visit.  
Assessment Note  
Tyler’s Health Issues and Treatments  
Edward and Tyler reviewed a CT scan of Tyler’s head, focusing on his vein anatomy and potential  
issues. They discussed how Tyler’s left jugular vein appears smaller and more constricted than the  
right, which Edward suggested could be contributing to cognitive issues and headaches. Edward also  
pointed out a fluid collection in Tyler’s left nasal cavity, which he suspected could be due to a skull  
fracture. They agreed to further investigate this finding.  
CSF Leak and Venous Treatment  
Edward explained to Tyler that his CT scan showed an old skull fracture from a 2012 concussion and  
suggested the presence of a CSF leak in the roof of his nose, which could be treated as a sinus  
infection for insurance purposes. Edward proposed addressing both the leak and the venous  
insufficiency simultaneously to provide symptom stability, acknowledging the complexity of the issue.  
Jugular Vein Stenosis Treatment Plan  
Edward and Tyler discussed the results of a Doppler study showing irregular flow velocity in Tyler’s  
left jugular vein, likely due to stenosis caused by the styloid and surrounding lymph nodes. Edward  
suggested that Eagle syndrome surgery, specifically a styloidectomy, could help address the issue.  
They also briefly touched on the possibility of checking for Lyme disease, though Tyler reported  
negative tests from a few years ago. Edward proposed an action plan involving fixing the left jugular  
vein through surgery and ensuring no distorted anatomy or inflammation is present.  
Nasal Roof Leak Surgery Discussion  
Edward explained the surgical procedure for fixing a leak in the roof of the nose, which involves  
examining the bony defect and making a judgment call on whether to reconstruct the roof aggressively.  
He mentioned that while some doctors may be reluctant to fix leaks that are not obviously singular  
cause broken, he performs this operation 6-8 times a week with a success rate of less than 1% for  
nerve injuries. Edward also discussed alternative treatments using blood thinners, diuretics, and  
platelet inhibitors, but noted that these treatments can sometimes make leak symptoms worse.  
Understanding Tyler’s Medical Condition  
Edward discussed Tyler’s medical condition, explaining that symptoms of Eagle syndrome and CSF  
leak have been present since at least 2013. He described how jugular vein compression and histamine  
production can lead to various health issues over time. Edward advised against intracranial stenting  
before surgery and explained that CT myelograms are not effective for detecting CSF leaks. He  
suggested using MRI with prolonged T2 sequence to visualize the leak and sinus disease. Edward also  
mentioned the possibility of EDS being a contributing factor to Tyler’s condition, but emphasized that  
it does not condemn him to a lifetime of symptoms.  
Recommendations  
-CTV to assess intracranial and extracranial venous outflow and evaluate pressure gradients.  
-MRI Cisternogram with \<1 mm slice thickness to correlate with prior CT findings and evaluate for  
possible CSF leak  
-pursue sinus surgery as sinus disease was noted on all imaging + include CSF leak repair + left  
jugular vein decompression  
Follow-Up  
Follow up via telehealth or in person with Dr. Hepworth.  
Based on current findings, anticipate that surgical intervention may be recommended to address both  
vascular and neurogenic components of compression.  
Clinical Considerations / Impression  
-Persistent left ethmoid sinus fluid pooling observed on all imaging; lack of response to antibiotics  
suggests this is unlikely infectious.  
-Findings suggest a transverse fracture of the posterior ethmoid roof (left)  
-If the defect were to resolve with conservative or pharmacologic management, it would typically have  
done so by now.  
-suspect a CSF leak occurring concurrently with venous outflow obstruction.  
-excess histamine contributing to the patient’s symptom cascade.  
-POTS is likely secondary to impaired venous outflow due to jugular vein compression.  
-history of pseudotethered spinal cord noted in consultation with Dr. Pedrefina.  
\*\*\*Intracranial venous stenting is not recommended at this time; venous outflow obstruction should be  
addressed first.

1. CSF leak
2. Intracranial hypertension
3. POTS (postural orthostatic tachycardia syndrome

My full thread is here…

> [@What to make of the ENTs view of my styloids](https://forum.livingwitheagle.org/t/what-to-make-of-the-ents-view-of-my-styloids/17794):
>
> I recently saw an ENT due to my suspicion of ES. After I gave him a HD CT taken in 2014 and CTV taken in 2021, he told me that my styloids were a bit long and a bit over 3cm. I asked about the angle and to which he had no reply, and the thickness wasn’t spoken of. I wanted to add some images here to show the styloid and ask others non medical opinions. I suspected ES after a diagnosis of hEDS and its other comorbidities. The ENT said he could do a shot, and if it helped surgery would probably be…

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