Extra- and Transcranial Echo Colour Doppler in the Diagnosis of Chronic Cerebrospinal Venous Insufficiency

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 107-113 ◽  
Author(s):  
P J Van Den Berg ◽  
L H Visser
Keyword(s):  
Venous Insufficiency ◽  
Venous Drainage ◽  
Cerebral Veins ◽  
Colour Doppler ◽  
Jugular Veins ◽  
Chronic Cerebrospinal Venous Insufficiency ◽  
Causative Relationship ◽  
Deep Cerebral Veins ◽  
The Individual ◽  
Relationship Of

A new venous disorder, chronic cerebrospinal venous insufficiency (CCSVI), has been proposed in patients with multiple sclerosis (MS). It is a vascular condition characterized by an impaired cerebrospinal venous drainage due to obstructions in the main extracranial cerebrovenous outflow routes (i.e. internal jugular veins [IJV] and/or azygos veins). In this review, the studies which assessed the prevalence of CCSVI in MS by echo colour Doppler (ECD) will be discussed. The technical aspects of determination of the five CCSVI criteria: (1) reflux in the IJV and/or vertebral veins in supine and upright position, (2) reflux in the deep cerebral veins, (3) high-resolution B-mode proximal IJV stenosis, (4) flow not Doppler detectable in IJVs and/or vertebral veins (VVs) and (5) reverted postural control of the main cerebrovenous outflow pathway are described in detail. We conclude that so far there are many studies with contradictory results, and as yet a strong scientific base to support the evidence for a causative relationship of CCSVI and MS is lacking. Recent studies call into question the validity of using ECD as a proper and reliable test for the diagnosis of CCSVI. One explanation for the variety in interpretation of the individual CCSVI criteria, with the wide-ranging percentages CCSVI, could be the different methods by using ECD to determine various criteria.

Assessment of jugular endovascular malformations in chronic cerebrospinal venous insufficiency: colour-Doppler scanning and catheter venography compared with intravascular ultrasound

2013 ◽  
Vol 28 (8) ◽  
pp. 409-417 ◽  
Author(s):  
F Scalise ◽  
M Farina ◽  
M Manfredi ◽  
C Auguadro ◽  
E Novelli
Keyword(s):  
Intravascular Ultrasound ◽  
Venous Insufficiency ◽  
Vascular Anatomy ◽  
Mean Difference ◽  
Maximum Diameter ◽  
Colour Doppler ◽  
Jugular Veins ◽  
Cross Sectional ◽  
Chronic Cerebrospinal Venous Insufficiency ◽  
The Mean

Objectives Chronic cerebrospinal venous insufficiency (CCSVI) is a malformative condition characterized by several anomalies of the azygos and/or internal jugular veins (IJVs). Recommended diagnosis of CCSVI is performed with colour-Doppler (CD) sonography. Though catheter venography (CV) is considered as the gold standard for determining vascular anatomy, its uniplanar point of view does not allow an overall evaluation of endoluminal structures. This limit could be addressed by intravascular ultrasound (IVUS). The aim of this report is to evaluate, in patients with multiple sclerosis (MS), the accuracy of CD sonography and CV versus IVUS in estimating the diameter and the cross-sectional area (CSA) of the IJVs and in detecting jugular endoluminal malformations (JEM). Method Forty-five MS patients with CCSVI, diagnosed by CD sonography, were submitted to CV during IJVs angioplasty. Twenty-five subjects were also examined with IVUS. The IJVs maximum diameter (MAXD) and CSA were estimated. CD and CV data were compared with IVUS data with the Bland-Altman method. Results The mean difference in IJV MAXD recorded by CD and IVUS was —0.5 mm. The mean difference in IJV MAXD recorded by CV and IVUS was 3.36 mm. The mean difference in IJV CSA recorded by CD and IVUS was —11.2 mm2. JEM recorded by IVUS were detected by CD sonography and CV with 88% and 32% accuracy, respectively. Conclusions CV was significantly inferior to CD sonography and IVUS in detecting JEM. Differences between IVUS and CD sonography in detecting JEM and in quantifying jugular diameters were not significant. The IJV CSA was underestimated by CD sonography compared with IVUS. CD sonography was proven to be important in the anatomical characterization of CCSVI, providing useful information for correct intravascular treatment.

scholarly journals A reliability study of colour-Doppler sonography for the diagnosis of chronic cerebrospinal venous insufficiency shows low inter-rater agreement

BMJ Open ◽  
2013 ◽  
Vol 3 (11) ◽  
pp. e003508 ◽  
Author(s):  
Maurizio A Leone ◽  
Olga Raymkulova ◽  
Ausiliatrice Lucenti ◽  
Alessandro Stecco ◽  
Laura Bolamperti ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Doppler Sonography ◽  
Rater Agreement ◽  
Colour Doppler Sonography ◽  
Colour Doppler ◽  
Reliability Study ◽  
Chronic Cerebrospinal Venous Insufficiency

Potential Involvement of Impaired Venous Outflow from the Brain in Neurodegeneration: Lessons Learned from the Research on Chronic Cerebrospinal Venous Insufficiency

2019 ◽  
Vol 14 (4) ◽  
pp. 235-236 ◽  
Author(s):  
Marian Simka ◽  
Marcin Skuła
Keyword(s):  
Venous Insufficiency ◽  
Neurological Diseases ◽  
Venous Drainage ◽  
Lessons Learned ◽  
Causative Role ◽  
Venous Outflow ◽  
Chronic Cerebrospinal Venous Insufficiency ◽  
Parkinson’S Diseases ◽  
Multiple Sclerosis Patients ◽  
The Brain

About 10 years ago, the so-called chronic cerebrospinal venous insufficiency syndrome was discovered. This clinical entity, which is associated with extracranial venous abnormalities that impair venous outflow from the brain, was initially found exclusively in multiple sclerosis patients. Currently, we know that such venous lesions can also be revealed in other neurological pathologies, including Alzheimer’s and Parkinson’s diseases. Although direct causative role of chronic cerebrospinal venous insufficiency in these neurological diseases still remains elusive, in this paper, we suggest that perhaps an abnormal venous drainage of the brain affects functioning of the glymphatic system, which in turn results in the accumulation of pathological proteins in the cerebral tissue (such as β-synuclein, β-amyloid and α-synuclein) and triggers the venous outflow from the cranial cavity and circulation of the cerebrospinal fluid in the settings of neurodegenerative disease.

No association between chronic cerebrospinal venous insufficiency and pediatric-onset multiple sclerosis

2012 ◽  
Vol 18 (12) ◽  
pp. 1791-1796 ◽  
Author(s):  
MP Amato ◽  
V Saia ◽  
B Hakiki ◽  
M Giannini ◽  
L Pastò ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Venous Insufficiency ◽  
Temporal Association ◽  
Causative Role ◽  
Window Of Opportunity ◽  
Healthy Controls ◽  
Jugular Veins ◽  
Chronic Cerebrospinal Venous Insufficiency ◽  
Pediatric Onset

Objective: Chronic cerebrospinal venous insufficiency (CCSVI) was hypothesized to play a causative role in multiple sclerosis (MS). The assessment of pediatric-onset MS (POMS) may provide a unique window of opportunity to study hypothesized risk factors in close temporal association with the onset of the disease. Methods: Internal jugular veins, vertebral veins and intracranial veins were evaluated with extracranial and intracranial ultrasound in 15 POMS and 16 healthy controls. Assessor’s blinding was maintained during the study. We considered subjects positive to CCSVI when at least two criteria were fulfilled. Results: CCSVI frequency was comparable between POMS and controls ( p > 0.05). Clinical features were not significantly different between CCSVI-positive and CCSVI-negative patients. Conclusions: Our findings add to previous data pointing against a causative role of CCSVI in MS.

Microsurgical anatomy of the great cerebral vein of Galen and its tributaries

2003 ◽  
Vol 99 (6) ◽  
pp. 1028-1038 ◽  
Author(s):  
Patrick Chaynes
Keyword(s):  
Venous Drainage ◽  
Pineal Region ◽  
Surgical Approaches ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Microsurgical Anatomy ◽  
Vein Of Galen ◽  
Content Type ◽  
Deep Cerebral Veins ◽  
Fine Print

Object. The deep cerebral veins may pose a major obstacle in operative approaches to deep-seated lesions, especially in the pineal region where multiple veins converge on the great cerebral vein of Galen. Because undesirable sequelae may occur from such surgery, the number of veins and branches to be sacrificed during these approaches should kept to a minimum. The purpose of this study was to examine venous drainage into the vein of Galen with a view to surgical approaches. If a vein hampering surgical access must be sacrificed, it can therefore be selected according to the smallest draining territory. Methods. The deep cerebral veins and their surrounding neural structures were examined in 50 cerebral hemispheres from 25 adult cadavers in which the arteries and veins had been perfused with red and blue silicone, respectively. Special consideration was given to the size and location of drainage of the vein of Galen and its tributaries. Conclusions. When a surgeon approaches the pineal region, several veins may hamper the access route. From posterior to anterior, these include the following: the superior vermian and the precentral or superior cerebellar veins, which drain into the posteroinferior aspect of the vein of Galen; and the tectal and pineal veins, which drain into its anterosuperior aspect. The internal occipital vein is the main vessel draining into the lateral aspect of the vein of Galen. It may be joined by the posterior pericallosal vein, and in that case has an extensive territory. To avoid intraoperative venous infarction, it is important to use angiography to determine the venous organization before surgery and to estimate the permeability and size of the branches of the deep venous system.

scholarly journals Chronic cerebrospinal venous insufficiency: masked multimodal imaging assessment

2013 ◽  
Vol 19 (11) ◽  
pp. 1499-1507 ◽  
Author(s):  
Staley A Brod ◽  
Larry A Kramer ◽  
Alan M Cohen ◽  
Andrew D Barreto ◽  
Thanh-Tung Bui ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Superior Vena ◽  
Vena Cava ◽  
Disease Process ◽  
Venous Drainage ◽  
Chronic Cerebrospinal Venous Insufficiency ◽  
Venous Circulation ◽  
Contrast Enhanced ◽  
Spectral Doppler ◽  
Clinically Significant

Background: Chronic cerebrospinal venous insufficiency (CCSVI) was implicated in the pathophysiology of multiple sclerosis (MS). Objective: We evaluated neurosonography (NS), magnetic resonance venography (MRV), and transluminal venography (TLV) in subsets of MS patients drawn from a single-center, prospective, case-control study of 206 MS and 70 non-MS volunteers. Methods: As previously reported, findings on high-resolution B-mode NS imaging with color and spectral Doppler of the extracranial and intracranial venous drainage consistent with CCSVI were similar among MS and non-MS volunteers (3.88% vs 7.14%; p = 0.266). Ninety-nine MS participants consented to intravascular contrast-enhanced 3D MRV to assess their major systemic and intracranial venous circulation, and 40 advanced to TLV that included pressure measurements of the superior vena cava, internal jugular, brachiocephalic, and azygous veins. Results: NS findings and MRV patterns were discrepant for 26/98 evaluable subjects, including four with abnormal findings on NS that had normal venous anatomy by MRV. In no instance were TLV pressure gradients indicative of clinically significant functional stenosis encountered. The three imaging approaches provided generally consistent data with discrepancies referable to inherent technique properties. Conclusions: Our findings lend no support for altered venous outflow dynamics as common among MS patients, nor do they likely contribute to the disease process.

Internal jugular thrombosis post venoplasty for chronic cerebrospinal venous insufficiency

2011 ◽  
Vol 26 (6) ◽  
pp. 254-256 ◽  
Author(s):  
◽  
A Thapar ◽  
T R A Lane ◽  
V Pandey ◽  
J Shalhoub ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Venous Insufficiency ◽  
Symptom Relief ◽  
Venous Drainage ◽  
Chronic Cerebrospinal Venous Insufficiency ◽  
Cerebral Venous Drainage ◽  
Endovenous Treatment

Chronic cerebrospinal venous insufficiency (CCSVI) is a hypothesis through which cerebral venous drainage abnormalities contribute towards the pathogenesis of multiple sclerosis. CCSVI venoplasty is already practised worldwide. We report the case of a 33-year-old lady with multiple sclerosis who underwent left internal jugular venoplasty resulting in iatrogenic jugular thrombosis requiring open thrombectomy for symptom relief. This occurred without insertion of a stent and while fully anticoagulated. Clinicians should be aware that endovenous treatment of CCSVI could cause paradoxical deterioration of cerebral venous drainage. Patients with complications post venoplasty are now presenting to geographically distant vascular units.

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