Surgery Date with Dr. Cognetti

[KoolDude]

So finally I got chance to update everyone about my case. After going through Styloidectomy with Dr cognetti my IJVS symptoms persist. Although the recovery from the operation was quick and uneventful, I did not get the benefits I was looking forward to. Long Story short, My doctor who is actually the only one familiar with IJVS in where I live has proposed to put an stent after discussing it with other doctors but I refused given the C1 involvement of my compression. They thought it was soft tissue and ligament (here they mean Digastric muscle) at C2 but I tried to explain to them that the C1 is pushing my left IJV to posterior belly of Digastric muscle as I will show you in the coming images. When I demanded them to trim the C1, they thought it was too risky, they could not do it since it was near the Vertebral Artery (See the note from their discussion below). I insisted stenting won’t work because of the C1 and it will be crashed and will even make things worse. I will only entertain that option once I get the C1 out of the way to give the stent a chance to work which they agreed at end.

So what happens if stent is put while there is C1 compression present. I will take an example of one of the members in this forum - (@Tikimon - whose stent was put while both Styloid and C1 were present (Very common practice within vascular doctors not familiar with bony compression). After symptoms remained unchanged, he sought to remove the Styloid in order for the stent to work. Styloid was removed by Dr Cognetti but C1 remained. Things have not changed for him and he posted the following image where you can see how the C1 is really pushing the stent and the thinning/narrowing lumen of the vein can be seen inside the stent. He was seeking to remove the C1 and I have not heard from him since. Simple, I did not want to end up like that.

@Tikimon

I just want to give an update and I appreciate so much of the support thay each of you who answered my questions and supported me along the way. Since my styloidectomy by Dr. Cognetti (which I highly recommend), I have since been to Wake Forest to have anothe stent placement to try and open up the original stent thay was placed BEFORE the removal of my styloid that was pressing against my internal jugular vein. Unfortunately with my luck I had the two issues of the C1 AND styloid pressing up against the internal jugular vein at the same time. So unfortunately I am in a situation where the C1 may need to be shaved off, as my headches, nose bleeds still signs of intracranial hypertension are still bithering me after removal of the styloid and a second stent in the internal jugular vein right at the C1 location. When I move my neck to the left, there is immediate contact with the C1 so, compression of the stent, unfortunately for me is unavoidable and therefore blood flow is compromised.
Anyway I just want to give an update and agin I apprecite ALL who have helped me up to this point. And again Dr. Cognetti did an outstanding removal of my styloid, as I had no first bite syndrome that I had seen a few others experience. So that in itself was/is a relief.
Thanks to all again. Not sure if I can upload a CT view of what I am experiencing to show what my unfortunate situation is. May be helpful to some to compare your situations.

Styloidectomy surgery coming up. Need help with information on post surgery symptoms

[Screenshot_20230217-142345_Gallery]

Here is the note from meeting of my doctors on my condition.

As you see my images below, keep in mind the @Tikimon’s case. You will see that the C1 is pushing my left IJV and would have crashed any stent that would have been put in.

Jan 2023 CTV: Just before the C1 compression, my left IJV appears to be fine (Light Blue Arrow). This is how the vein should look like at the C1 level if it is not compressed by it

The picture is different, when my IJV (Light Blue Arrow) at the C1 level. As you can see, the C1 (Red Arrow) is pushing it towards the posterior belly of digastric muscle (Cyan Arrow). It is clear that the C1 is stretching it and compressing the IJV

Jan 2023 CTV: Here are the 3D rendering of it . The red circle is where the digastric muscle is and you can see the compression of the whole segment all the way up to the Jugular Foreman.

So, I just wanted to let anyone know that sometimes even the best of doctors with good intentions will not do the research for you when it comes to IJVS. You need to educate yourself about the potential consequences of any intervention and its long term effect. I am not saying C1 trimming is risky free or minor surgery but in my case, it makes sense even if stent was to work post C1 surgery.