I don’t think doing one side first is inherently a “more professional” approach. It is one surgical strategy, but not the only reasonable one.
I had bilateral styloidectomies performed on consecutive days, and I’m very glad I did. Whether surgery is staged or bilateral should really depend on the individual anatomy, symptoms, surgical approach, and surgeon’s judgment rather than being framed as one approach being more professional than another.
That’s what I was talking about — they look at each case individually and don’t do it for everyone from both sides.This is what is called a professional approach. For example, Dr. Agaev, he suggests removing it from both sides right away for everyone.
That’s a different point from what you originally wrote. Individualizing the surgical plan to the patient is obviously appropriate. My only disagreement was with characterizing a one-side-first approach as inherently “more professional.”
Why did I mention just one side? )))))))))))You’re just nitpicking. Of course, I meant an individual approach, for example, if the other side isn’t severely compressed. And Dr. Agaev ALWAYS suggests doing both sides at once, even if one side has partial stenosis and is asymptomatic (no pain). He doesn’t measure the pressure; he only relies on CT and MRI images, and that’s it.
This was what you said, I did take it to mean that you feel doing one side first is more professional…
@MGORNEAU But do you really think that when a doctor tries to injure the body less, and does it only from one side, when one side is enough? And he doesn’t offer to do everything from two sides at once. Is it not professional?
@Filya That is not what I disagreed with; I disagreed with your original statement that a one-side-first approach is inherently more professional.
Can you message me i have an appt with Dr Liu in a week.
I just messaged you!!
@Mr.Finer Are these screenshots from the portal imaging? I know you said you’re still in NJ, and the portal doesn’t provide an option to download the DICOM files, which you can then open in software with a 3D viewer. I’m still waiting for my own post-op CTA from them.
When you’re able, I’d be really interested to see a 3D reconstruction so we can see the actual length of styloid remaining. For example, these are my right side before and after styloidectomy with Dr. Osborne; the residual styloid is circled in green on the post-op image. He was able to cut it back close to the skull base, although not completely flush with it.
I’m also anxious to see the removal of my bridged arcuate foramen on my own post-op imaging in 3D. It’s just much easier to visualize the anatomy and exactly what was accomplished that way.
I’m really curious to see how close Dr. Liu gets to the skull base with the styloid resection based on his incision approach,
purely out of curiosity.
@MGORNEAU I got you! I’ll send it when I get home. I’m flying back on Tuesday 
I’m sorry your good surgical results didn’t last longer & that you’re facing a revision surgery. I’ve had to go that route, too.
I have been on this forum since 2014, & in the 12 years I’ve been here reading (& replying to) posts, we have had quite number of members who had initial quick surgery recoveries but then had regression with symptoms flaring again at the 2-4 month post op recovery period. Many of these people went on to have more significant recovery from symptoms in the 4-12 month period post op especially when IJV decompression had occurred. Thus your thought that if symptoms don’t return after a month or month & a half “victory has been achieved”, is truly not an accurate healing time frame. It can take 2+ months for post op swelling to fully resolve, & as long as there is inflammation, nerves & vascular tissues can continue to be compromised to some extent & so be causing symptoms. A number of us have had symptoms that took close to a year to resolve because nerves are slow to recover, thus a more realistic point at which to evaluate recovery is the 6-12 month post op period.
For those who’ve had compromised IJVs, the brain/body adjustment period, once blood flow improves, can take quite a number of months. Because of that, it can be 4-6 months or more before a person begins to feel a significant improvement. We emphasize that patience is vital when recovering from either an ES or vES surgery.
I’m giving you this information so you don’t have a false sense for the timing of your own upcoming recovery. Expect it to take at least 4-6 months before you feel significant improvement. If your body heals faster then that is cause for celebration!
@Mr.Finer That is awesome! Rest up and heal, so glad you are on the other side of this! 
@Mr.Finer & @MGORNEAU - It looks to me like you each have about the same styloid stub length post styloidectomy. Though it’s not flush w/ the skull base, that length should be short enough to provide a good recovery.
Here is my several-years-post-op CT. Though my surgeries were “advertised” as being skull base styloid resections, they didn’t end up being very close to the skull base. I had good resolution of nerve pain from both surgeries, however, I had to have the left one revised as trigeminal nerve pain flared up after several years, & it was also causing IJV compression.
@Isaiah_40_31 “I can see that, ugh, I’m really sorry that happened. That resembles my left side, which still curves in pretty heavily near the carotids. 
I just hope it doesn’t continue to calcify over time; with how much calcification I tend to have, that’s definitely something I think about.”
I’m sorry your left side was left longer than expected, @MGORNEAU. In the end, I think the surgeons remove what they feel they can safely & hope for the best. It seems that some surgeons are more confident in getting right up close to the skull base whereas others aren’t & even those who have a reputation for cutting the styloids very short, occasionally leave someone’s longer than we’d expect.
@Isaiah_40_31 I understand that can certainly be true in some cases, but I don’t think that explanation really fits what happened with mine. Dr. Osborne specifically performs and advertises skull-base styloidectomy and has expressed a high degree of confidence in his ability to work very close to the skull base. There was never any indication given to me that the remaining length on the left had to be left for safety reasons or because he couldn’t reach it.
I don’t know why the left side was left longer. One possibility I’ve wondered about is whether what happened after the right-side surgery influenced the approach to the left. I woke up with complete right side facial paralysis after the right side styloidectomy. Dr. Osborne knew the nerve was intact, so it was most likely neuropraxia. Thankfully, it resolved quickly, I could close my eye and smirk about three hours after returning to the hotel. The right styloid was nevertheless cut shorter.
@MGORNEAU That sounds like a very reasonable explanation. There are several cranial nerves emerging at or near the styloid. As I understand it, the surgeons are able to visualize the nerves but only know how much they are disturbing them if they use nerve monitoring. It could certainly be that he visualized the nerve that gave you temporary paralysis after the first surgery and decided to be more conservative. The surgical plan for my second surgery was the same as my first but changed dramatically once the surgical field was exposed. Dr. Nakaji decided not to do the C1 shave because it had a nerve draped over it and it was giving him too much “chatter” to proceed. When I saw him later that day he explained the changes to the surgical plan. I’m sorry Dr. Osbourne didn’t discuss it with you. Did you get a copy of your surgical notes? They should be a play-by-play of the decision making during surgery.
@Chrickychricky I did get the operative notes, but unfortunately they’re pretty vague and read more like a repeated template than a detailed play-by-play of the intraoperative decision-making. Dr. Osborne does use intraoperative nerve monitoring.
