I’m sorry I meant to reply yesterday but got distracted!
Normally we’ve suggested that getting the dominant side first would seem to make more of a difference to the flow in that vein & help your symptoms resolve quicker; if you don’t have much flow in your smaller side, everything goes through the dominant side, so if that’s also compressed as you say to 50% then I would’ve thought to remove that first would have more impact?
But reading through an old discussion, @anon67578920 posted this:
‘As Doctors Peter Nakaji and Michael Lawton wrote and as I think based on hydrodynamics, it is necessary to remove compression from the non-dominant side. Why ? Because the resistance of the weak side (non-dominant side) is greater, and when you release the dominant side, the blood flow will increase, but on the non-dominant side it will decrease (because fluid, like electric current, flows more along the branch where the resistance is less) and in the end you further reduce blood flow on the non-dominant side. As a result, you get headaches in that hemisphere, etc. In general, I think that if there is significant compression on both sides, then you need to operate on both sides after some time. Why ? Because after 1-2 years, the distribution of blood flow will improve and the veins will begin to change their sizes and in the end, on the one hand there will be a small deficiency. Of course, there won’t be any special or strong symptoms, but still. only if you have poor metabolism and are prone to arteriosclerosis, the transverse sinus may gradually, over a couple of years, thrombose due to low speeds.’
So there you go, not any clearer? Here’s a link to the discussion:
1 year (almost) post right sided styloidectomy/C1 resection update - Symptoms and Treatments - Living with Eagle
I’ve not heard of anyone being told that their dominant side was the smaller side before either!
I’m afraid I don’t know anything about transverse and sigmoid sinus stenosis, so can’t comment about that…
We do suggest that members try & get at least 2 appointments for opinions, but we have seen some members who have seen the more well known VES get differing opinions, which then makes it extremely hard to decide what to do! I guess sometimes you have to consider your gut feeling & how confident you feel with the doctor, and ease of travel etc for the surgery… Is it worth trying to get a consultation with Dr Nakaji in AZ? Although he does requite a CT venogram pressure manometry I believe- some members have travelled to get that done with Dr Mehta and then been assessed for surgery within a few days. But that seems to vary too!