@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