@Luckee7 I see that you’ve found many of the landmarks in your imaging. Nonetheless, Id be happy to take a look through the entirety of your imaging if you’d like. Members seem to be appreciative of my annotations. If this is something that you are interested in, I’d just need you to put your CT files into a google drive folder and send me a link to the folder. You’d no longer be anonymous to me but I’d keep your personal information private. Let me know what you think.
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Thank you. I always thought those were collaterals too. What happens to those after surgery? If the jugular veins are open, then perhaps the collaterals wouldn’t need an alternative route? I don’t know if you can get rid of those.
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@Luckee7 -
I asked about that when I had my IJV decompression, & the answer was when the collaterals are no longer needed, they gradually diminish. I don’t know if they ever go away completely. Maybe our bodies hang on to them in case of another vascular emergency. I had significant occipital pain from mine periodically, but that is gone now.
Thanks so much for looking at my 3-. Those look like collaterals to me too. I’ve never thought that that could be the reason why I cannot be upright. They could be getting compressed just by gravity.
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@Luckee7 I had terrible left-sided suboccipital headaches from collateral blood flow that completely resolved with the left-sided surgery. I guess I’m not sure why but my assumptions is that the blood is flowing through the IJVs now instead of the collaterals.
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I might be wrong, but my understanding was that these veins were already present, but only small as they’re not needed to take much blood usually, and that they swell with the IJV compression to take more flow which can then cause pain…
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That’s great to hear.
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Hi Luckee7. I had a consultation with Constantino Oct 16. While seeing Dr. Hauser in Florida for prolotherapy injections to help correct CCI he had me go for a CTV because his imaging test showed bilateral elongated styloid process. The CTV showed right side jugular 80% compressed and Dr Hauser prompted me to have a consultation with an ENT surgeon. Well Constantino said since I do not have the symptom of something stuck in my throat surgery wasn’t necessary since all of my pain is on my left side. I guess I should be happy but still concerned. He suggested going for the catheter/balloon test but still hasn’t sent me any information as promised. I’m headed back to Florida to see Dr, Hauser again for another prolotherapy treatment and to check my curve correction exercises I’ve been doing since my last visit there. I have another consultation appointment with a surgeon in NYC in December
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I’m surprised that Dr Costantino didn’t think you needed surgery if you have IJV compression! Not everyone has the feeling of something stuck in their throat… Do you have other ES symptoms like pain in your neck, nerve pain in your jaw or face etc.?
If you want a second opinion about this, Dr Cognetti in PA treats vascular ES, as does Dr Hepworth in CO & Dr Nakaji in AZ. Dr Hackman in NC has done lots of successful surgeries for ES as well, although he doesn’t check that the IJV has been decompressed.
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I completely agree w/ @Jules. We’ve never heard of Dr. Costantino turning a patient w/ IJV compression away because they didn’t have a specific ES symptom like the sensation of something stuck in your throat. Kind of crazy! I DID NOT have that symptom but had many others caused by my elongated styloid.
Since you’ve been diagnosed w/ an elongated styloid & IJV compression, it would be a good idea for you to pursue doctors who specifically treat that unless your follow-up w/ Dr. Hauser demonstrates that restoring your neck curve has taken pressure off your IJV & it’s more open now. If that is the case then seeing one of the non-vascular ES surgeons on our forum would be just fine.
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Thanks for your reply Jules! I was very surprised by what he said. I went there expecting to get a date for surgery ! I told him I was concerned about getting a stroke because of the compressed jugular. He said, two times, you will not get a stroke from this 
. I’m seeing Dr Hauser Tuesday. I recorded my consultation with Constantino and played it back on an app called coconotes and it put together a summary of my time with Constantino and I will present it to Dr Hauser!!
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Also Dr Hauser recommended the Dr in North Carolina that you’ve suggested !!
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Your right styloid is long, pointed & has a curve to it. Your left side is a significantly calcified section of stylohyoid ligament which is also curved. I can see that your left IJV is being squashed by the piece of calcified ligament but since the picture is from the front, I can’t see how C1 is involved.
What Dr. C told you about IJV compression not causing strokes is mostly true. It’s carotid compression or being poked by the styloid or calcified ligament that can cause TIAs or in a worst case scenario, a stroke.
Additionally your right & left internal carotid arteries are very tortuous & the right one looks like it could be being compressed by the the small vein where it crosses over the ICA, just below the tip of the styloid, &/or poked by the tip of the styloid. Your left ICA also looks very close to the tip of the calcified ligament.
If I were you, I’d ask Dr. Hauser to comment on the tortuosity of your carotids & how close the ICAs are to the tips of the styloid & calcified stylohyoid ligament when you see him. Also ask about C1 as it looks extra thick from the front view & different from top to bottom on the left than on the right. I realize that may just be a function of the particular photo you posted.
I’ve done a little annotation of your image, but I couldn’t tell which one in the tangle of veins/arteries on your left side is the ECA.
We have another member who has a unique situation w/ the vascular system in her neck, & she is seeing Dr. Nakaji for surgery. With the way your ICA/ECAs look, it would be a good idea for you to get an opinion from Dr. Nakaji, too.
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@SusanD I agree with @Isaiah_40_31 - the tips of your styloids are very close to your ICAs. The way to truly know if they are in contact with them is by looking at the axial view of the CT imaging. If you want, I can look through the entirety of your imaging to point out anything I see. I am mainly concerned about the styloid tips as from this angle look like they could be a stroke risk. If you want me to look through the entirety of your CT, you can out your CT files into a google drive folder and send me a link to the folder so I can download the imaging. You’d no longer be anonymous to me but I wouldn’t be sharing any of your personal information. Let me know your thoughts.
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Thank you Isaiah for responding! Seeing you agree with Jules as well I will definitely continue getting this looked into. I’ll post again after seeing Dr Hauser !
I appreciate your time and help!!
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Yes! I would appreciate that so much!!! Not being tech savvy I’ll have to figure out how to send to you. I’ll be looking into that. Cannot thank you enough for your help!!!
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Thank you Isaiah. You’re very educated with all of this and I truly appreciate all your help!!!
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@SusanD - @TML just had his surgery today so it may be a while before he is able to respond to you regarding any imaging you send him. He prefers for the entire CT scan to be uploaded into a Google Drive folder & sent to him via Private message here. All you need to do to send him a PM is click on his screen name as it appears in this message. That will take you to his profile page where you can click on the blue MESSAGE link to get started on a PM.
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