@Shauna Dr. Liu used imaging software available to him at Cooperman Barnabas to evaluate my arcuate foramen. During my consult he was actually skeptical that it was causing the problem. He told me he wanted to review everything with the imaging software and then reconnect with me in about two weeks to go over the risks before deciding on surgery. Three days later, I got a call with a surgery date, so whatever he saw on that review was clearly enough to change his mind.
I had a DSA with venous manometry the day before surgery. It did show pressure gradients, but it did not show a blockage. The study was also only done from C2 upward, so it did not tell us exactly what was causing those pressures. Importantly, the DSA/VM was used for additional diagnostics and surgical planning, it was not what determined whether the arcuate foramen surgery was necessary.
I’ll be two months post-op on 10/11, and the “baseball bat bashing me in the back of the head” pressure is gone. The pressure behind my eye is not gone, and I still have lightheadedness. Dr. Liu had noted before surgery that I still had IJV compression at C1 and that a C1 shave might be warranted depending on what symptoms remained afterward but that the arcuate foramen took precedent. I could not have agreed more!
Based on the symptom resolution I’ve had, I feel very confident that de-bridging the arcuate foramen was a solid step in the right direction. I’m definitely not looking forward to potentially needing another surgery to decompress the IJV, but the symptoms that remain are consistent with IJV compression. 
A consult with Dr. Liu is $500, so it may be worth reaching out to his office. I would be very specific that you are requesting the consult for evaluation of the arcuate foramen, not for Eagle syndrome.
When I contacted him, I had already had bilateral styloidectomies, and the arcuate foramen was a separate consideration that came up afterward during a consult with Dr. Aghayev.
If you proceed, they will most likely send you the Eagle intake form. It is long and very detailed. I filled out every section completely rather than referring them to another question, and I was very specific throughout of my symptoms, even if it was repeated 10 times.
The reality is that Dr. Liu was not convinced at first that it was the issue. I had to be very blunt that my consult was specifically for the arcuate foramen and that I wanted that anatomy reviewed. He then took the imaging back to the software available to him at Cooperman Barnabas, and whatever he saw on that review was enough for him to feel surgery was warranted in my case.
