Surgery May 16 with Dr. Lo and Dr. Costantino in NY

Hi everyone,

I’ll be having surgery May 16 at the hands of Dr. Larry Lo and Dr. Costantino in NY. My hope is to share my case so that other’s can learn what to look for when diagnosing themselves for Vascular ES, VES, or Internal Jugular Vein Stenosis, IJVS. Also to have a log of how my recovery goes.

My symptoms are purely IJVS related as my styloids are not long, but are very thick. Also based on my CT images I can see larger protrusions coming from the C1 that I and my surgeons believe is the main cause of the stenosis.


  • Consistent pressure in the forehead. Never goes away, I go to sleep its there, I wake up it’s there. If I go upside down I get immense pressure in the same way. This was my main complaint for almost 20 years until new symptoms started to form.

  • Headaches - I do get some bad headaches a few times a month. Not too much of an issue, I have learned not to look down for extended periods of time as this will induce a headache.

  • Light sensitivity - I cannot stand a light source in my direct or peripheral vision. At work and at home I have a low light source behind me.

  • Visual distortions - While I have been check multiple times by ophthalmologists I have a visual haze that is worse in low light situations. Also noticed ghosting from reflective surfaces when I move.

  • Tinnitus - High pitched electrical hum that can switch from ear to ear. When I clench my teeth really hard the sound intensifies.

  • Dizziness - minor dizziness, I get hit with little waves of dizziness every once in awhile. I call them waves because it comes and goes so quickly.

Previous treatments

  • Honestly for the longest time I thought I had bad allergies. So I saw an allergist and got allergy shots for years.

  • I have seen 3 ENTs over the course of a decade.

  • 2 neurologists. 1 looked at my scans and missed the signs of IJVS and the other refused to look at the scans, probably because she didn’t want it as a liability.

  • All sorts of other things like eating certain foods and trying prescribed medications various blood testing from my PCP. Nothing helped and if anything just made me feel worse.

My Scans

I had an MRI with contrast taken for “headaches” in 2010 and that is where the radiologist should have seen that my right transverse sinus was hypoplastic and at least commented on it. Because I had the same MRI repeated in 2021 and 2022. From those scans I repeatedly went back to look at the images and eventually found the defect myself. That led me to finding that in addition to a hypoplastic right transverse sinus, I have bilateral internal jugular vein stenosis.

I only mention this because if you think you have IJVS please learn how to read your own scans or post anonymous pictures with your scans on this form so others can help you. Don’t depend on radiologists or neurologists to figure this out for you.

Axial MRI with contrast of the transverse sinuses - Red outline is hypoplastic right transverse sinus. The blue outline is the left transverse sinus (it looks like there is a missing piece because it goes higher up in the scan and then comes back down again)

Sagittal MRI with contrast of left jugular vein - Jugular vein outlined in red. Notice the indentation caused by C1.

Axial MRI at the level of C1 - Blue arrow points to compression of left jugular vein. You can also see the right jugular vein is compressed on the opposite side. See the measurement of 1.32mm.

Axial MRI at the level of C2 - See how the IJV opens up to a normal diameter of 9mm just at C2 only an inch/few centimeters further down.

Left Styloid (outlined in red) with distance to C1 - You can’t see the IJVs on CBCTs, but its jammed between those 2 pieces of anatomy. This is my dominant side and should be doing the majority of the blood outflow.

Right Styloid (outlined in red) with measurement to C1- this is the hypoplastic side. So it is much less important


May 16, I will be undergoing styloidectomy and a C1 shave/resection on the left side. Dr. Costantino will perform the incision, styloidectomy and removal of minor muscle tissue to make a path to C1 and then Dr. Lo will shave down the outer edge of C1 to make an area for the jugular vein to drop in.

I should also mention that once I discovered I had a stenosis I initially consulted with Dr. Patsalideds and he did a venogram/angiogram with manometry. Because he focuses on stenting procedures and not styloidectomy or C1 shaving he referred me to his colleague Dr. Lo. I will post those separately they also have some interesting and relevant results, but I feel like the MRI with contrast was a dead give away for VES/IJVS. You just need to know what to look for.

@KoolDude @Buzz I realize we have very similar cases because of our similar anatomy and have been watching your stories closely.


@GCD - Thank you for this really informative post. I agree whole-heartedly that learning to read our own scans is critical & helpful, plus it will allow us to better advocate for ourselves. I’m preaching to myself here as I’ve long relied on the likes of @vdm & @KoolDude & some others to “translate” the images people post.

I expect you’ll notice significant & good changes once your left IJV is flowing properly again. Even though your styloids aren’t long, they are quite dagger-like so I’m not surprised they’re symptomatic.

Exciting that your surgery is coming up soon! I’ll be praying for you & the surgeons on 5/16.


First I could not have agreed more on the above statement :100:. No doctor or radiologist would do that for you. I also would like to say good job :clap:. You really have my respect learning/figuring this stuff out and helping folks as I saw in a number of recent posts. You really must be good at reading MRIs to get the compression out of an MRI imaging which, unlike, CT does not show the bones well.

I also would like to wish you a success on your upcoming surgery :pray: and I will be following your case closely as I am myself searching for C1 atlas shaving. I am assuming Dr Lo has done this a number of times before. The thing to watch for is Vertebral Artery and Accessory nerve which are close to the C1 atlas. So I hope Dr. Lo pays extra attention to them during the surgery.

I also see the similarity but if you do not mind, I would like to study any imaging you have further to see why the left transverse sinus appears to be discontinued (only if you want it). I am pretty sure Dr. P has been thorough with the Catheter Venogram and if any issues, it would have been caught in that study (assuming he measured the pressure gradient on left TSS). There is site where you can share your imaging anonymously (personal information is stripped off from the images before uploading). If you are ok with sharing it, There is a site and it is called ( and there is video on how to upload and share your images on it. I find it convenient way in sharing MRIs/CTs anonymously but you need a faster upload speeds on your internet connection or it will take a bit of time if you are uploading huge MRI/CT sequences. I am pretty sure you have already studied them to death but if you need additional pair of eyes, I am ready to assist, otherwise, I am ok if you do not feel the need.

Wishing you all the best.


Dear GCD. Thank you for sharing so much about your case history.
I’ll be thinking of you on the 16th and wishing you all the best for your surgery and recovery!


Well done for educating yourself & looking into your own scans!
Will be thinking of you on May 16th & will be praying for a successful surgery, hope that it is the solution for you :pray:


Best wishes and complete healing!!!


@GCD Hoping all goes well! Will be thinking of you and yours this week. ))


@GCD The best of luck for your surgery tomorrow! :pray: Hopefully everything goes well!

We’ll be waiting for your update with anticipation.

That’s fantastic! You should be so proud of yourself.

I had the same experience. Multiple scans of the area over my lifetime, without the radiologists or doctors noticing anything. I found it a decade later while scrolling through the DICOM images and thinking “that looks odd”.

The hilarious thing is that I showed my mother the 3D view of my contrast CT and she immediately said “doesn’t that vein look compressed?” before I had even mentioned it :joy:

Sometimes I think that doctors and radiologists have “blinders” on for things that they’re not specifically looking for.

I would be very interested to see those images to compare with my venogram once its completed.

That’s a nasty-looking left TSP you’ve got. The way that it curves back towards the C1 it almost looks like an eagle’s talon.

It seems like you’ve found the perfect surgeons for your situation. I’ll be praying that it all turns out perfectly for you!


Hi everyone @Isaiah_40_31, @KoolDude, @KimberlyNYC, @Jules, @PamelaInNYC, @Leah, @Buzz

Thank you for wishes and the response to my surgical post! I made that post right before leaving working and then heading out to NY on Sunday with the family.

Checked in for presurgical testing today at the hospital. So all set for the big day tomorrow.

@KoolDude Below is a link to my MRI scans. The left transverse sinus looks like it is missing a piece, but it’s just higher up in the scan. I used that level to show what a hypoplastic transverse sinus looks like on the right side. This website is an awesome find btw!

@Buzz I couldn’t believe when said your CT with contrast was from 2014. It’s so clear that have you have severe stenosis at the level of C1 bilaterally. It should have been an easy diagnosis from there. I will share my full venogram when I get a chance, because I have seen very few of those types of scans when looking for comparisons. Here are 2 screenshots.

See you all on the other side…


@GCD - Sending you a hug for encouragement & expectations for good things to result from tomorrow’s surgery!

:hugs: :pray:

1 Like

Loved your comment about @GCD’s styloid looking like an eagle’s talon!! It’s true - it does!!

1 Like

May it be smooth sailing all the way!


@GCD My prayers are with you :pray:. I hope the surgery goes smooth. I will have a look at the MRI but looking the at Catheter Venogram image you posted, it looks fully patent. Good images to convey the message.

1 Like

Thinking of you, hugs & prayers :hugs: :pray:

Hoping you’re beginning to “come to” after your surgery a few days ago. Surely it takes a few days to recover from the anesthesia medicines alone, let alone the actual treatment. Rest and lots of pillows and patience…

I’m next Wednesday, so I’ll be in your shoes, ahem, more likely pajamas.



Sending you best wishes in the days leading up to your surgery, Violin. I hope everything goes smoothly for you.


Hi everyone just wanted to give you all an update of how I have been doing since the surgery.

I woke up with almost little to no pain, but definitely groggy from the anesthesia. The hospital decided to serve ribs for dinner that night and I was able to eat them to my surprise. The worst part was the drainage tube placed behind my ear. It made it hard to sleep that night.

I wish I could say that I woke up and the pressure in my head and other symptoms were gone, but I have been having mild headaches since the operation. I believe it is from the swelling in the general region or maybe a cold that I got during my travels because I have been a little mucousy since the operation and can feel it in my sinuses. So I will have to wait until the swelling goes down to be able to tell if the operation was successful for me. I know a lot post op patients have posted that it take a few weeks before you start to feel the actual affects from surgery, so I will be patient.

I was discharged from the hospital the day after the surgery. I have been able to walk and do some work remotely. But I do get tired easily and can feel that my body is in recovery mode. Luckily nothing is really painful, I am trying to take it easy. Tonight I get to remove my bandages to see the incision site.

Dr. Lo did confirm with me once the styloid and part of C1 was removed that my vein reopened during the surgery, but we will have to see on imaging a few months down the line to confirm it has stayed open.


Thanks Violin, I wish you the best for your upcoming surgery.

It definitely is going to take awhile to recover fully, luckily it is relatively painless, just a little uncomfortable. Probably the worst part was the drain and the IVs while your in the hospital. Once that got removed I felt a lot better.


It certainly would make sense that after surgery, you could actually feel worse in the area due to swelling and inflammation. And as you know time will take care of that.

Because my situation came on acutely, I feel like I have the situation where inflammation affected everything in that area. It is settling… But slow.
That being said, did they prescribe a steroid pack? If not, you might ask for that… It might be stated as a course of steroids.

Suspect the good news is they took care of your problem and I suspect you’ll have a really really good results. Crossing fingers and toes!


Glad that you’re not in too much pain & are taking things easy…it’s weird after a big surgery but I found the drain was the worst bit too! Can’t believe you ate ribs just after it though, good you could chew, alot of us needed smoothies/ soft foods for a bit!
Brilliant that you vein re-opened, :pray:it stays that way.