Surgery advice - have I missed anything?

@DogLover i do not have a date yet as I told them that I won’t be back to the country until march 17th. I think they might give me the date when I come back.

Nope, I am not getting the C1 shaving either, just Styloid removal on the left side.

As far as the vacation goes, it is not really a vacation per se, we are visiting family members in the Middle East, but at the same time trying treat it as one. Weather does help as it is mid 20 degree Celsius here. Kids and wife appear to be enjoying it most though I am managing it just ok with ES symptoms. I try not to be held prisoner by ES.

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Good for you. It’s still hard though I bet. It’s worth the effort just to watch your kids I’m sure. Keep us posted with your date and I will certainly post how my surgery goes.

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Can’t see it at all, but because the skin is quite tight behind your ear I do feel it a bit from time to time, so still massage it with oil.
@KoolDude I think Mr Axon has refined his technique so he doesn’t cut any muscles which some doctors do, so that makes it less painful & less swelling (in addition he does use a drain overnight), but M_UK had surgery with him & still experienced symptoms post surgery, so don’t know about that…

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@DogLover will definitely keep you posted when I get the firm date. Yeah, if my kids are happy, that is enough.

@Jules i think it is different when they drill/shave the C1 transverse process. The had to cut muscle tissue that uses the C1 as an anchor in order to access it so that they can shave it if I remember it well. So in theory, it is much deeper surgery than Styloid removal alone hence long recovery. I think that was the case with M_UK if I recall it correctly. I assume the less muscle involvement the quicker the recovery with the least amount of swelling. The problem is the muscle healing takes time and swells after the surgery and collapses the thin wall of the Jugular Vein exasperating IIH symptoms. This is my assumption regarding the lengthy period for symptoms relief after surgery.

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I LOVE your attitude of not letting (or trying not to let) ES symptoms hold you captive! I’m sure the warm weather where you are vs the freezing cold Canadian weather is making a big difference even if only in frame of mind. Warm sunshine is very healing in so many ways! :sun_with_face::bouquet::lady_beetle:

Has anyone heard from @M_UK lately?..

He seems to have disappeared suddenly, after the last post mid December

I’m still here. Unfortunately 3 months post op I still have not experienced any significant gains from the surgery. The next step is to have another CTV to see how things look but the wheels move very slowly with the NHS…

Oh man, so sorry to hear that… I know everyone here expects immediate relief and only some of us have it… Hopefully, things will turn right for you soon too, given that one of the impingement causes is gone now.
Besides the surgery, did the docs investigate any other less common causes like vertebral artery impingement, thoracic outlet syndrome, herniated discs?..

Yes I have discussed all of those things with Dr Higgins and he could not see any evidence of them apart from the jugular compression.

Thanks Kooldude for that info - forewarned is forearmed! Do you know which muscle? This is the muscle which I think is involved in my compression, because when I put pressure on my back at the mid point, around T5 T6, I feel all sorts of sensations in my right jaw, head and up into my ear.
Cervical spine: Anatomy, ligaments, nerves and injury | Kenhub

@DogLover i am not sure which muscle but you can see the one attached to the C1 atlas in the picture you provided is definitely involved.

If you really want to know what you & @Dontgiveup will go through you need to read the following section in Dr Axon’s study in the research area (Dr. Higgins & Dr. Axon : Spontaneous Intracranial Hypotension Complicated by Subdural Effusions Treated by Surgical Relief of Cranial Venous Outflow Obstruction). It details how Dr Axon does this operation and includes a number of muscles as well.


**Left Styloidectomy and C1 Transverse Process Resection**

Prior to the procedure, axial CT images were used to decide the extent of transverse process resection required to free the jugular vein from posterior compression, bearing in mind limitations imposed by the position of the vertebral artery as it passes through the transverse foramen ( Fig. 2B ). Reformatted images or trigonometrical calculations can be used to calculate the length of styloid that should be removed to achieve adequate anterior decompression.

The procedure was performed under general anesthesia with continuous intraoperative facial nerve monitoring. The patient was laid supine with the head slightly extended and turned away to the contralateral side. A postauricular incision was extended forward in front of the mastoid tip and then inferiorly into the neck avoiding the path of the marginal mandibular branch of the facial nerve. The anterior border of the sternocleidomastoid muscle was dissected free up to, and in front of, the mastoid tip. Further dissection medially through the deep cervical fascia toward the carotid sheath enabled identification of the posterior belly of the digastric. Palpation of the inferior wound identified the bony transverse process of the C1 vertebra and further dissection superoanteromedially, anterior to the posterior belly of the digastric, identified the body of the styloid process. The posterior belly of the digastric was drawn anteriorly and dissection continued posterior to the muscle until the prevertebral muscles were identified overlying the transverse process. Care was taken not to injure the internal jugular vein, which occasionally can be draped over these prevertebral muscles.

The prevertebral muscles were divided by sharp incision onto the bony transverse process, and the periosteum gently stripped from its tip. Malleable retractors were helpful in this regard. A 2-mm course cut diamond burr was used to gently create a hole that was then widened to enter the cancellous bone. This bone was easily drilled, thus gradually widening the aperture and keeping within the periosteal pocket, bearing in mind the anatomy in relation to the vertebral artery identified on prior CT.

Attention was then turned to the styloid. Blunt dissection toward the base of the styloid process above the inferior extent of the mastoid tip enabled an approximation of its origin. Two small malleable retractors were inserted in front and behind the styloid process, so giving secure anchorage to hold the soft tissue from its surface. A 2-mm course cut diamond burr was used gently to create a hole that was then widened in an anteroposterior direction to drill across its diameter. Bone bwas removed until its medial extent was egg shelled. At this point, the whole of the styloid process became mobile. A House Bone Curette was used to draw the base of the styloid process laterally until it could be safely held using a curved Spencer Wells forceps. An ophthalmic microsurgical blade was then used to gently strip the muscle attachments from its surface in an inferior direction while drawing the styloid superolaterally. The stylohyoid ligament was divided using scissors and the styloid process removed. At this point, the excised styloid measured 14 mm and compared with its preoperative length on CT imaging (19 mm) as described above. About 3 mL of residual styloid was still attached to the skull base after taking into account the 2-mm drill diameter. Malleable retractors were again used to hold soft tissue away from the styloid remnant, and this was drilled away to its base. Hemostasis was confirmed and a suction drain inserted. The wound was closed in layers.

He was nonspecifically unwell for 2 or 3 weeks following surgery, describing liquid sloshing around in his head with movement but gradually his headaches improved and within a month he was back at work. Follow-up MRI showed resolution of the subdural collections and restoration of normal brain anatomy ( Fig. 1C and ​andF ).F ). The CT venogram showed expansion of the left jugular vein into the space created by removal of the styloid and C1 transverse process ( Fig. 4B ), although there was some residual venous narrowing just below the skull base. The right internal jugular vei

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Hey Dog lover,
Scrambled eggs worked great for me! I hate to admit it, but I got Jimmy Dean Breakfast Bowls for meat lovers. They tasted good and only takes 2-3 minutes in the microwave! Didn’t have to hardy chew…goes down easy. My other favorite was macaroni & cheese. They both seemed to settle the stomach from pain meds and after surgery nausea. Not much tasted good but for some reason watermelon pieces tasted refreshing and they are soft. I went to a hair salon 4 days out to get my hair washed and it was a god send as I wasn’t up to trying to do it.
I dont recall if Dr. Axon gives out steroids for after surgery but this worked like a charm and kept my need for pain meds very low. I still use my wedge pillow as it does double duty for acid reflux. My 2 mini-doxie’s have taken a liking to the top of the wedge pillow since my ES surgeries so I made them a special bed up there behind my head. Dogs just know when their masters are not feeling well.

Im having oral surgery on St. Patricks day myself…Im nervous as hell because a tooth extraction last July set me back into major jaw pain…this after recovering from ES surgery in 4/19 and 12/20. The pain was so bad, I ended up in ER. I told my dentist, Id much prefer ES surgery over a tooth extraction! Pretty bad when you’d rather get your neck cut open than get a tooth extracted. You are in excellent hands and you will come out on the other side just fine. May the luck of the irish be with you on your surgery day! :shamrock: :shamrock: :shamrock:

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So sorry that you’ve not seen improvements, really disappointing, I hope that the CTV shows something…thinking of you

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Mac cheese - good call! I’ve just ordered some ready made as I’m too tired to cook any more. Also just added water melon to the order - that sounds a real good idea too.

My dog had a big procedure on his neck a while ago so maybe I could pinch some of his steroids (jk), I’ve got my eye on his gabapentin too!

I have my wedge pillow ready and several dogs to choose from (an essential part of recovery). Many thanks for the reply & very best of luck for Thursday. I hope you have your steroids at the ready. :slightly_smiling_face:

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Hi M_UK,

I’m so sorry you’re still struggling w/ nasty vascular symptoms. It can take removal of both styloids for the symptoms to go completely away. I know you’ve read that here.
We hope when one side is opened up symptoms will decrease but sadly that’s not always the case.
I hope you don’t have to wait too long for the testing to see what’s going on. I still hope things improve for you. :hugs:

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I’m so sorry you’re facing more time in the dental chair, Snapple! I will pray for you on Thursday & going forward that you don’t experience anything close to the pain of last time around.
:heart::pray:t3:

Hope your procedure goes well too :hugs: :pray:

They just cancelled my surgery!

Oh no, that’s so rough! :tired_face: Unfortunately typical NHS…plans on hold again for you, I hope that you get another date soon, sending you a really big hug :hugs:

It’s not NHS - it’s Mr Axon. Not postponed- cancelled! He said the brachiocephalic was more to blame they thought and my symptoms were too varied. To say I’m devasted doesn’t begin to describe how I feel. He also said there wasn’t a doctor in the world who would operate on the brachiocephalic at the moment.