Effect of Long-Term Head and Neck Venous Outflow Obstruction on Cognitive Function: Evidence From Patients With Internal Jugular Vein Stenosis

Surgical cohort Procedure (routine clinical care, not a study intervention) Patients undergo atlas transverse process resection combined with release and perfusion technique according to clinical indications. The procedure aims to relieve bony compression of the internal jugular vein by the atlas transverse process. Postoperative follow-up is performed according to routine care. The study does not alter surgical indications or the operative procedure; it only observes changes in MoCA scores and imaging-based venous outflow indicators at 1, 3, and 6 months after surgery.

Healthy control group (case-control component) Observational comparator group Age-, sex-, and education-matched individuals without IJVS or head and neck venous outflow obstruction, matched 1:1 to the case group.

Inclusion Criteria:

Cohort study (surgical cohort / non-surgical cohort):

Age 18-65 years, either sex. Confirmed by head and neck CT venography (CTV), MR venography (MRV), and jugular vein ultrasound as extrinsic IJVS caused by atlas transverse process compression, with a stenosis rate ≥50%.

Voluntary participation and signed written informed consent. Able to cooperate with MoCA cognitive assessment and related examinations at all scheduled time points.

No severe hepatic or renal insufficiency, coagulation disorders, or other severe underlying diseases.

Surgical cohort: no surgical contraindication and willingness to undergo atlas transverse process resection combined with release and perfusion technique. Non-surgical cohort: willingness to receive conservative treatment without surgery and no urgent surgical indication during follow-up.

Case-control study-case group:

Clinically confirmed IJVS with disease duration ≥6 months. CTV-confirmed IJVS caused by atlas transverse process compression. No history of previous cerebral infarction, intracranial hemorrhage, Alzheimer's disease, or other known causes of cognitive decline.

Complete baseline clinical and imaging data available.

Case-control study-healthy control group:

Age-, sex-, and education-matched individuals without IJVS, without head and neck venous outflow obstruction, and without severe organic disease or a history of cognitive impairment.

Exclusion Criteria

Cohort study:

Cognitive impairment caused by another definite etiology (e.g., Alzheimer's disease, cerebral infarction, cerebral hemorrhage, hypothyroidism).

Severe psychiatric disease preventing cooperation with cognitive assessment and study procedures.

Neck surgery, radiotherapy, or internal jugular vein intervention within the previous 3 months.

Pregnancy or breastfeeding. Malignant tumor, autoimmune disease, or other condition with an expected survival of less than 1 year.

Long-term use of sedative-hypnotics or cognitive-enhancing drugs that may affect MoCA assessment.

Refusal to participate in follow-up or inability to complete all scheduled assessments.

Case-control study:

Other imaging-detected venous abnormalities, such as venous sinus stenosis or jugular vein reflux, or the styloid process identified as the main compressive structure causing IJVS.

Severe heart failure or other major cardiac dysfunction. Severe hearing impairment or other conditions that may affect the validity or completion of cognitive assessment.

Intrathoracic or intracranial space-occupying lesions, cerebral vascular malformations, or other abnormalities on high-resolution chest CT, brain MRI, or CT that may constitute a major hemodynamic obstruction.