I was wondering if vascular ES and ES have different surgical approaches/treatment options or are the main differences the symptoms you feel. If you have vascular ES is it important to go to a surgeon that specializes in that or could any other ES surgeon work?
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@RitaPita My compression was addressed by removing the styloid above the compression point, relieving the vascular impingement without needing a C1 shave. It’s very dependent on surgeon skill, comfort near the skull base, and individual anatomy. In my case, the compression, especially on the right, was right at the skull base. I don’t know that every ES surgeon would be comfortable managing a complex styloidectomy at that level, but I would expect them to be upfront about their experience. Dr. Osborne performed my bilateral styloidectomy.
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@RitaPita One thing I would add, focusing only on the vascular side can sometimes miss the bigger picture. If you go strictly the vascular route, neurologic symptoms can get overlooked, and styloids may be dismissed unless there’s clear, significant vascular compression on imaging. But styloid involvement can absolutely contribute to symptoms beyond just IJV compression. In my case, I had both vascular and nerve-related symptoms, and addressing the styloids helped with more than just the vascular component.
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Thats exactly the case with me, there is no clear significance compression on imaging, but I believe it is impacting me. Thanks for your insight! I’m glad to hear Dr Osborne helped give you relief as he is the closest surgeon near me.
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If you’re already consulting with Dr. Osborne, I’d trust his judgment. He’s not going to offer surgery unless he genuinely feels it’s appropriate for your situation. He’s not only very skilled, but also thoughtful in how he approaches cases.
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It’s important to see a doctor experienced with ES with either classic or VES. It varies alot though- we’ve had lots of members who have more than one medical condition and possibly more than one compression, or complications from those compression, so in those cases it’s best to see one of the more experienced VES docs- for example sometimes with IJV compression, it can cause such high pressure in the brain that it can cause a CSF leak, which might need patching/ repairing. And if the C1 or soft tissues are causing compression as well as the styloid process, then these might also need resecting to achieve proper blood flow, which the VES doctors will check & do. But if the compression is more from the styloid process, like @MGORNEAU 's was, and mine was too, then as long as an experienced surgeon can remove the styloid as close to the skull base as possible then it will hopefully remove any compression on the IJVs and so the surgery should be successful…
Hopefully the nerve symptoms that go along with ES would be eased with whichever surgeon you went with whether it’s one who specialises in VES or not.
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So for me originally, my symptoms were a lot of jaw, neck, and shoulder pain. The last couple years things like headaches and ringing in the ears started up. I had surgery on one side by a ENT in February. Things were really bad and I was just desperate for any kind of relief.
My surgeon didn’t have a ton of experience with eagle syndrome. But he had done a few surgeries and I trusted his skill and be able to do the styloidectomy. The surgery and recovery has gone really well with that. And my jaw Pain along with a number of neurological symptoms are so much better! But I still have pressure, headache, headaches behind my eyes and a building pressure warming sensation sometimes when I’m chewing on the back of my head.
I met with my surgeon today for my two month postop. I told him about my improved symptoms, and the ones that haven’t improved much. And he implied that perhaps I didn’t have eagle syndrome at all or there is something else going on because with the styloid being removed that should’ve fixed everything. he also told me he doesn’t know a whole lot about Eagle syndrome. It was a little bit of a frustrating appointment because he kind of stated at one point that the surgery was not a success because I still have symptoms. But I was like are you kidding me? I can eat solid food again!!!
I was hopeful that simply removing the styloid would fix everything. But now I’m seeking consult to look more into the vascular component. I do wish I would have had more information (like a consult from a more experienced dr., more in depth scans, etc) before doing the first side. But I also don’t regret doing before getting more information because life was getting really hard to live.
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Hi! @Bay I‘m so sorry your still experiencing symptoms. As a chronic migrane sufferer, I know it can’t be fun. I am glad you found a little relief though and listened to your gut about what you needed in that moment! I reccomend looking into a neurologist who deals with vestibular migrane as it could help explain what you are feeling and lead to some helpful treatment. Right now, I am hopeful with the surgery that it could clear my throat pain and my head pain but it is good to know that it may just help with one and that is good progress!
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I’m sorry that you still have symptoms, but good that you’re being positive about the ones which have improved…it’s so hard to make the right decision about doctors, and understandable that you needed surgery sooner rather than leaving it to get second opinions etc. Hopefully now your body will be stronger to cope with a revision surgery if you do need one and decide that, but it is still early days as symptoms can still improve months afterwards. Do you have bilateral ES? That can make a difference sometimes to how much you improve after surgery, it may be that the other side needs doing?
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Yes, I do have bilateral ES. By looking at my CT scans, the doctor felt my left side was worse than my right, but my right side was definitely more painful to live with. So we did the right side. I’m sure the left side needs to be done because I have some nerve issues on that side that affect my palette and make it hard to bite into things.
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@Bay, the best thing you can do is get a CT scan with contrast if your diagnosing CT was not done with contrast. That will show the impact your remaining styloid & styloid stub are having on your IJV & possibly your ICA. If your diagnostic CT was done w/ contrast, then converting the images to 3D may be helpful for you to see what’s still going on in your neck. (radiantviewer.com for PCs & Bee Dicom Viewer App for Macs)
Many of us who have bilateral styloid elongation have found that it took 2 surgeries to fully relieve nerve pain symptoms & for those w/ bilateral IJV compression, having both IJVs decompressed was ultimately required.
Other members have had similar situations to yours where their ES surgeons weren’t very experienced w/ the surgery & when symptoms didn’t completely go away after the first surgery, they declined to operate again to take out the second styloid. It’s a mistake on any doctor’s part to think that when there are two elongated styloids, removing only one, even if it’s the most symptomatic, will stop all symptoms. Often the symptoms caused by the remaining styloid flare up considerably after the first one is removed. I had that experience. I also had to have a revision surgery on the left side after my first two styloidectomies because I had IJV compression that was missed. I will say that my decompression & revision styloidectomy was my easiest surgery to recover from. I’ve joked my body knew what to expect by then. 
I agree with @Jules that you’re still in somewhat early recovery from your first surgery. It would be worth it to consider getting a consult w/ a more experience ES surgeon especially one who deals w/ IJV compression just to make sure that’s not a problem for you.
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