Aims: Extracranial compression of the internal jugular vein (IJV) is increasingly recognised as a contributor to symptoms of intracranial hypertension. When medical therapy fails, several surgical options exist to address compression at the C1 level. Our unit uses a standardised procedure combining styloidectomy, IJV fasciotomy and resection of the C1 transverse process. This study reports outcomes in 27 patients who underwent this combined approach. Methodology: Patients with symptoms of intracranial hypertension and imaging-confirmed IJV compression were assessed in a multidisciplinary meeting. Those with persistent symptoms despite medical therapy and who elected surgery were included. Demographics, radiological stenosis grades, Symptom Severity scores and Quality-of-Life (QOL) measures were collected pre-operatively and at 3–6 months post-operatively. Ethics approval was obtained from the Sydney Local Health District (X24-0101). Descriptive and comparative analyses were performed in StatsDirect. Results: Twenty-seven patients were treated between January 2023 and January 2025. Significant post-operative improvement was seen across all domains. Mean IJV stenosis grade improved by 1.89 points (p<0.0001). All Symptom Severity scores except dizziness showed significant improvement, with headache improving most (Δ = 1.42, p=0.0002). Overall QOL improved by 1.13 points (p=0.006), with 10 of 15 QOL indicators showing meaningful gains. Conclusion: In carefully selected patients with persistent symptoms and imaging evidence of IJV outflow obstruction, combined styloidectomy, IJV fasciotomy and C1 transverse process resection provides significant improvements in symptoms, QOL and radiological stenosis. These results support targeted venous decompression as a viable treatment option for patients with medically refractory intracranial hypertension symptoms.