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

Super good news that you’re doing so well, @GCD! “You hit the nail on the head” regarding as to the probable reason for your headaches - post op swelling. That can continue to cause vascular compression & nerve irritation. As it decreases over 2-8 weeks, your symptoms will begin decreasing, too. Beware of the urge to jump back into life w/ both feet as you begin feeling better. That will likely ramp up some of the symptoms & put you a few paces backwards. I think most of us have been there & done that during recovery.

Sending you a healing hug :hugs:


@GCD That’s brilliant news! Keeping my fingers crossed that your symptoms decrease as time goes on.


I have never heard of these surgeons?

@Bc2 - These doctors are in New York & are new names on our forum but have reportedly done quite a number of ES surgeries together. We have several members in NY who have vascular ES w/ the transverse processes of C-1 playing a larger part in IJV compression than the styloids. Dr. Costantino will remove the styloid & Dr. Lo will shave a little off the TP of C-1 to make more room for the IJVs so they can open back up & stay open. Drs. Costantino/Lo don’t do bilateral surgery so their patients will have 2 surgeries if their situation is bilateral.


Thank you for thinking of me. I think at least one of those doctors Dr. Patsalides recommended to me too.

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We have at least one other member whom Dr. Patsalides referred to Dr. Costantino, as well.

I am so glad that you made it to other side. It is normal for the coming weeks to feel up and down and pain might get bit worse but that is normal healing process. Ice, ice to keep the inflammation and swelling down. Wishing you a full recovery.


(Thank you all for thinking of me and my upcoming surgery! —violin)


H GCD, I hope you are recovering just fine. I know the first week is a battle having gone through Styloidectomy myself I know how it feels. I know yours will even be worse since C1 and Styloid were both removed. Hang in there.

I quickly took a look at the MRI, Nothing to report other than C1 compression of your IJV which you already knew. However, I was able to segment the left Transverse Sinus (TS) to confirm that it was continuous and dominant. You can also see in the 3D segmented image how much the C1 atlas was compressing it (Yellow arrow)

One more thing. I see something on your teeth and I suspect it is metal filling artifact of T1 MRI. See the Image below (Cyan arrow). Can you confirm that it is actually metal filling but nothing else. Other fillings do not show up like this on MRI so it must be METAL one.


9 Days post op now. So here’s my update.

The mild headaches stopped at about day 7 after having a really bad headache on day 6. Still have the head pressure and brain fog that I had before the surgery.

I forgot to mention in my previous post that the tinnitus sound (high pitched electrical noise) for me increased post op. I assume it is due to the swelling increasing the symptoms temporarily. So it will be interesting to see if it correlates with my head pressure symptoms as time goes on.

Also, my left ear and area around the incision is numb. My surgeons warned me before surgery that this was unavoidable as they have to cut through a small nerve to reach C1. They assured me that most of the numbest will dissipate with time.

I was cleared by Dr. Lo in my post op appointment to go back home on day 6. Day 7 I flew back home and was able to walk around the airport by myself without any issues. Day 8, I worked at home remotely and today, day 9, I am back at work, but I sit behind a computer the majority of the time.

So I’m pretty much back to normal now, I just can’t lift anything too heavy or exercise. I can feel the tightness of the stitches in my neck when I turn my neck, but it doesn’t hurt. I just limit the neck movements mainly when driving.

3 days post op - I was able to remove the first big bandage. There is still a clear bandage on during this picture.

7 days post op - I removed the clear bandage. You can see the swelling along the incision line. There are dissolvable stitches still keeping it all together.

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Glad to see, you are making a rapid recovery in terms of wound healing. As you guessed, it is probably swelling that is collapsing the thin-walled IJVs.

Here is @M_UK who went through both Styloidectomy and C1 trimming in UK by Dr. Axon just like you. He did an excellent comparison Pre and Post surgery IJV flow 9 months afterwards. He quantified it using computational fluid dynamics.

We also discussed it here after 5 days of his surgery. It also includes links to studies of neck operations and IJV narrowing as result of it. Kinda gives you perspective on what to expect. Hang in there. You need at least 3 months to assess it. See the study in the link below.


Hi @KoolDude,

It’s very kool of you to make the images into a 3D reconstruction. It’s way easier to visualize the IJV stenosis since you isolated just the venous system.

I had a root canal in my left upper molar, so that is the artifact that you are seeing in my teeth. You don’t miss anything…


@kooldude Thanks for resharing @M_UK posts. I had read them before, but mostly forgotten them at this point. The CTV image he shows post op and a comparison 9 months later is a great verification of the swelling that takes place. So I will try to be patient.

Also here is a link to my venogram MedDream viewer (

These are my pressure readings during the procedure:

Upper IJV - C1 Head Straight - 10
Upper IJV - C1 Head Right - 11
Upper IJV - C1 Head Left - 11
Upper IJV - C1 Head Neck Flexion - 20
Upper IJV - C1 Head Neck Extension - 9
Mid IJV - C4 Head Straight - 9
Mid IJV - C4 Head Right - 8
Mid IJV - C4 Head Left - 9
Mid IJV - C4 Head Neck Flexion - 7
Mid IJV - C4 Head Neck Extension - 8
SSS Head Straight - 14
SSS Head Right - 13
SSS Head Left - 13
SSS Neck Flexion - 22
SSS Neck Extension - 11
SSS Balloon Inflated Head Straight - 24
SSS Balloon Inflated Head Right - 30
SSS Balloon Inflated Head Left - 20
SSS Balloon Inflated Neck Flexion - 40
SSS Balloon Inflated Neck Extension - 16

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I was able to find moderately Dilated Optic Nerve Sheath (ONS) with CSF Fluid which is a known marker for raised intercranial pressure. So perhaps, your Optic Nerve could have been under CSF pressure. But then you already know that since you have all the signs of IIH. Let us hope all this disappears in 3 months time after IJVs open up.

MRI T1 shows Dilated ONS with CSF Fluid ( Red Arrows - CSF is Dark on T1). The right Optical Nerve Sheath appears to have more CSF Fluid on one side then the left has equal ONS sides. Do you feel more eye symptoms on the right eye?

MRI T2 shows Dilated ONS with CSF Fluid ( Red Arrows - CSF is bright on T2). It only shows one side due to MRI sequence timing. I am sure it exists both as the MRI T1 above shows.


@GCD Awesome, Will have a look at the Angiogram. Those pressure readings are high. I hope they come down.

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The incision is looking really good- once it’s healed completely then you can start to massage it…glad that you’ve been able to go back to working already & that the headaches have eased. Numbness around the ear is very common after surgery, mine’s never gone completely but it’s a small price to pay…I hope that the head pressure & tinnitus improve soon :pray:


@KoolDude this is actually really helpful. I tried many times to look for excess fluid in the optic nerve, but could never see it. However there it is! Thanks!


Hi Jules! Thanks for response. I agree the numbness is a small price to pay.


Yeah, you are right it is bit difficulty spotting it on T1. If you had MRI FIESTA sequences, that one depicts ONS better. You can also see most of cranial nerves as well. Even normal MRI Axial T2 with large number of slices (thin slices) can capture it. The problem is your T2 is standard 27 slices so it does not capture the whole Optic Nerve and it sheath. I had to go to T1 for ONSD clues.


@GCD It would be amazing if you could share the imaging with us when you eventually get it done, if possible.

I would love to see the IJV, and how much of the styloid and C1 was removed.