# Cerebral Venous Outflow Insufficiency: A Study on Symptoms and Venous Stenosis Classification

## TL;DR

This study identifies symptoms and classifies cerebral venous outflow insufficiency into three types to improve diagnosis and treatment.

## Contribution

A novel anatomical classification system for CVOI based on lesion location and jugular narrowing rates is proposed.

## Key findings

- Tinnitus cerebri, neck discomfort, and tinnitus are the most common symptoms of CVOI.
- Tandem-type CVOI (CJV) is the most prevalent subtype and has distinct symptom patterns.
- Narrowing thresholds of 0.20 and 0.40 show excellent performance in differentiating CVOI subtypes.

## Abstract

Cerebral venous outflow insufficiency (CVOI) is a recently recognized cerebrovascular condition characterized by impaired venous drainage from the brain to the extracranial system. However, its clinical phenotypes and classification criteria remain poorly defined. In this single‐center cross‐sectional study, we analyzed 245 patients with CVOI using contrast‐enhanced CT or MR venography to identify clinical features and propose a novel anatomical classification. We identified 10 major symptoms of cerebral venous congestion, with tinnitus cerebri, neck discomfort, and tinnitus being the most common. A new classification system was proposed based on lesion location and bilateral jugular foramen narrowing rate, categorizing CVOI into intracranial (CV), extracranial (JV), and tandem (CJV) types, each further stratified into four/five subtypes. Receiver operating characteristic (ROC) curve analysis showed that narrowing thresholds of 0.20 and 0.40 offered excellent discriminatory performance for subtype differentiation, with an area under the curve (AUC) approaching 1.0. Notably, tandem‐type CVOI (CJV) was the most prevalent (56.7%) and exhibited distinct symptom patterns and pathogenesis. These findings provide a practical framework for diagnosing and stratifying CVOI and may inform individualized treatment strategies.

Cerebral venous outflow insufficiency (CVOI) predominantly consists of 10 cerebral venous congestion symptoms. Based on the traditional classification according to imaging features, this study classified CVOI into intracranial (CV), extracranial (JV), and tandem (CJV) types, which better reflect the imaging features and pathological types of patients to guide clinical management.