Surgery Date with Dr. Cognetti

For Nutcracker syndrome, I found a doctor in Russia, Alexander Vasiljev, who is fond of vein compressions like Nutcracker syndrome, May Turner syndrome and vein compression by TOS, but not of VES. He makes vein stenting. I came occasionally at his video on youtube on EDS, where he also talked on Nutcracker syndrome. And there I understood that I most probably have it… Doctors in Belarus who I turned to, all have heard of this condition being students, but never diagnosed it (now I see, they didn’t even know, what tests are needed). They didn’t take my assumptions seriously and refused to make any tests. So I went to Moscow, where that doctor made a selective CT venogram, and my assumptions were confirmed. Later it was yet also confirmed in Belarus, through additional tests.

Dr. Vasilhev is the only one in the whole country who makes stenting for the NS, although, as he himself admitted, not always successfully. I visited him in 2020, and by that time there were just around 30 people, who received this treatment from him. First I was considering it, but then came across FB group on Nutcracker and understood, that this option might be not so good.
I was considering renal autotransplant or even nephrectomy, but the doctors in Belarus refused it, meaning the vein pressure gradient was not high enough in my case, and hence the OP not indicated. The symtoms I have did not count. Later Dr. Vasiljev explained, that measuring pressure gradient is not informative, since it changes constantly, depending on many factors, including body position. My symptoms aggravate when sitting, while tonometry was made in supine position.

What concerns VES, I can’t say exactly for the classic type and carotid type, but for the jugular type I have, there’s absolutely no specialist neither in Belarus, nor did I find him in Russia. I found the ES and IJV compression on my CT scans myself, (having already gained experience in reading it from experince with the Nutcracker syndrome). Dr. Vasiljev played a role in it, since he checked my cerebral veins during the CT venogramm too, and found a huge aneurism on my right condylar emissary vein. He didn’t know, where it comes from, or what it can cause, and what one can do with it. But for me this turned out to be a clue, which later helped me to come to the right diagnosis through deduction method, and know where to look at at my CT scans (thanks God, this area was captured OCCASIONLY on a CT scan, initialy made to check for another condition).

First, I turned to some neurologists, who turned out not to be competent at all at this area, couldn’t read CT scans, didn’t take my assumptions seriously and ascribed all my symptoms to depression, anxiety disorder, panic attacks and tension type headaches. Until I found a neurosurgeon in my city, very curious, ingaged and open minded, who agreed with me, admitting, that I am a very unique case, have definitely more knowledge about this condition than he himself, and that there’s absolutely NOONE in our country, who is fond of cerebral vein compression issues.

He sent me to a clinic in Minsk, the main clinic in our Republic for neurology and neurosurgery, where it turned out to be just one spinal neurosurgeon, who had made an OP for classic ES, just once, not knowing the outcomes of it, since the patient never showed up again.
There was a consillium on my case, out of 3 doctors: 1 spinal neurosurgeon, 1 endovascular neurosurgeon and 1 neuroligist. Officially, they confirmed that I have the jugular compression on both sides, mainly through the C1 vertebra, but it “is compensated through the venous outflow”. Since there are no signs of intracranial hypertension on my MRI. They didn’t make lumbar punction or any other investigations to check the IIH. When I noted, how come, it is compensated, when the symptoms are there, and the collaterals are so extremely delated, the answer from the spinal neurosurgeon was “compensated through this delation”.
There’s an outdated common postulate which I had to hear quite often, which sounds like “there are numerous pathways for the blood out of the brain, the blood will ALWAYS find its way out”, so my symptoms can’t come from the IJV compression.
When I talked later in private with 2 other doctors from the consillium, they admitted, that they know absolutely nothing about this condition, and the research base for it is still very small. And that they would put their competence under question, if they prescribe a surgery they have never made, with unclear outcome, which is also so extremely dangerous (they admitted, I need C1 TP resection, just styloidectomy would not help).

They offered me to turn to Burdenko clinic in Moscow, this is the main and most high rated clinic for neurosurgery in Russia. I sent there an email with all my CT scans more then 6 weeks ago, but no answer arrived. I also sent an email to Dr. Konovalov, very famous and high rated spinal neurosurgeon in Russia, working as head of the spinal neurosurgery department in the Burdenko clinic, and the answer came short: surgery not indicated. Just these words, without further details. So I left the idea to find a surgeon close to my area. The neurosurgeon in my city agreed, that it doesn’t seem that anyone in Belarus or Russia is competent enough in this area, and I have to search for a doctor abroad.

So this is how in the end I came across this forum, and am really glad, that it happened…

Actually, I was not going at all to make this post THAT LONG…)) But somehow it all poured out of me on itself. Feels like I just needed to share it with someone, who really CAN UNDERSTAND… Since there is no such person in my surroundings at present.

I find this forum amazing. I can’t describe, how grateful I am to all, who share their experiences, ideas, insights, studies, other information and support here. It is incredibly helpful.
Especially huge thanks to @Isaiah_40_31 and @Jules :pray: You are just great, guys. And your contribution to helping us is enormous :heart:

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