Surgical treatment for cognitive impairment caused by internal jugular vein stenosis: a clinical study of atlas transverse process resection

Background and objectives Internal jugular vein (IJV) stenosis, often caused by extrinsic compression from the atlas transverse process, may impair cerebral venous drainage and contribute to cognitive dysfunction, though direct clinical evidence is limited. This study aimed to investigate the correlation between atlas-induced IJV stenosis and cognitive impairment, and to evaluate the effect of surgical decompression on cognitive outcomes. Methods From January to June 2025, 47 patients with radiologically confirmed IJV stenosis due to atlas transverse process compression were prospectively enrolled. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Patients were stratified into higher ( n = 24) and lower ( n = 23) stenosis groups based on the mean of IJV stenosis degree (IJVS degree) for exploratory comparison. Of these, 16 patients completed the strict postoperative outpatient follow-up, including MoCA assessment. Results The mean MoCA score for the cohort was 23.21 ± 3.41, indicating cognitive impairment. The higher stenosis group had significantly lower MoCA total scores than the lower group (20.79 ± 0.56 vs. 25.74 ± 0.38, p < 0.001), with pronounced deficits in visuospatial/executive function and delayed recall. Partial correlation analysis, controlling for age and education level, revealed a significant negative correlation between IJVS degree and MoCA score ( r = −0.66, p < 0.001). Postoperatively, the mean MoCA score improved from 22.56 ± 0.82 to 24.68 ± 0.64 ( p < 0.001), with significant gains in visuospatial/executive function, attention, and delayed recall. Conclusion This study indicates that internal jugular vein stenosis caused by atlas transverse process compression is a potentially treatable contributor to cognitive dysfunction. Surgical decompression improved cognitive function, providing direct evidence for the role of the cerebral venous system in cognitive health. Evaluation of patients with cognitive complaints should consider assessment of the head and neck venous system.