Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis – Old-New Concept, New Questions?


Authors: MUDr. Ondřej Doležal, Ph.D.
Published in: Cesk Slov Neurol N 2011; 74/107(3): 357-360
Category: Commentary

Overview

The concept of chronic cerebrospinal venous insufficiency (CCSVI) as one of the crucial etiological factors in multiple sclerosis (MS) has begun to emerge recently. This study is a review summarizing all that is known and published about CCSVI, together with the author’s long-term experience in the fields of multiple sclerosis and stroke, providing groundwork for critical discussion. In the light of our experience, the concept of CCSVI cannot be ignored and it is essential that extensive future studies into it be performed. We feel that recently-published expectations are overestimated (based upon our own ultrasound examination results in 10 MS subjects and 10 healthy controls). Use of PTA (percutaneous transluminal angioplasty) and stenting as a therapeutical approach in venous insufficiency, without taking physiological and anatomical findings into account, has not to date proved objectively beneficial and is not indicated in MS patients. Neither is it approved by acknowledged authorities such as the Food and Drug Administration of the USA.

Key words:
chronic cerebrospinal venous insuficiency – multiple sclerosis – percutaneous transluminal angioplasty – stenting – ultrasound examination


Sources

1. von Rindfleisch GE. Lehrbuch der pathologischen Gewebelehre. Zur Einfuhrung in das Studium der pathologischen Anatomie. Erste Lieferung: Leipzig 1866.

2. Putnam TJ. The biological significance of the lesions of multiple sclerosis. Science 1934; 80(2074): 295–296.

3. Fog T. On the Vessel-Plaque Relations in the Brain in Multiple Sclerosis. Acta Neurol Scand Suppl 1963; 39 (Suppl 4): 258–262.

4. Talbert DG. Raised venous pressure as a factor in multiple sclerosis. Med Hypotheses 2008; 70(6): 1112–1117.

5. Schelling F. Damaging venous reflux into the skull or spine: relevance to multiple sclerosis. Med Hypotheses 1986; 21(2): 141–148.

6. Zamboni P, Galeotti R, Menegatti E, Malagoni AM, Bartolomei I, Salvi F. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80(4): 392–399.

7. Zamboni P. The big idea: iron-dependent inflammation in venous disease and proposed parallels in multiple sclerosis. J R Soc Med 2006; 99(11): 589–593.

8. Tallantyre EC, Morgan PS, Dixon JE, Al-Radaideh A, Brookes MJ, Morris PG. A comparison of 3T and 7T in the detection of small parenchymal veins within MS lesions. Invest Radiol 2009; 44(9): 491–494.

9. Tallantyre EC, Brookes MJ, Dixon JE, Morgan PS, Evangelou N, Morris PG. Demonstrating the perivascular distribution of MS lesions in vivo with 7-Tesla MRI. Neurology 2008; 70(22): 2076–2078.

10. Qiu W, Raven S, Wu JS, Carroll WM, Mastaglia FL, Kermode AG. Wedge-shaped medullary lesions in multiple sclerosis. J Neurol Sci 2010; 290(1–2): 190–193.

11. Zivadinov R, Schirda C, Dwyer MG, Haacke ME, Weinstock-Guttman B, Zamboni P. Chronic cerebrospinal venous insufficiency and iron deposition on susceptibility-weighted imaging in patients with multiple sclerosis: a pilot case-control study. Int Angiol 2010; 29(2): 158–175.

12. Singh AV, Zamboni P. Anomalous venous blood flow and iron deposition in multiple sclerosis. J Cereb Blood Flow Metab 2009; 29(12): 1867–1878.

13. Zamboni P, Menegatti E, Weinstock-Guttman B, Schirda C, Cox JL, Zivadinov R. The severity of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis is related to altered cerebrospinal fluid dynamics. Funct Neurol 2009; 24(3): 133–138.

14. Sundstrom P, Wahlin A, Ambarki K, Birgander R, Eklund A, Malm J. Venous and cerebrospinal fluid flow in multiple sclerosis: a case-control study. Ann Neurol 2010; 68(2): 255–259.

15. Zamboni P, Consorti G, Galeotti R, Gianesini S, Menegatti E, Carinci F. Venous collateral circulation of the extracranial cerebrospinal outflow routes. Curr Neurovasc Res 2009; 6(3): 204–212.

16. Zamboni P, Galeotti R, Menegatti E, Malagoni AM, Gianesini S, Salvi F. A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency. J Vasc Surg 2009; 50(6): 1348–1358.

17. Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs – UIP consensus document. Part I. Basic principles. Vasa 2007; 36(1): 53–61.

18. Cavezzi A, Labropoulos N, Partsch H, Ricci S, Caggiati A, Smith PC. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs – UIP consensus document. Part II. Anatomy. Vasa 2007; 36(1): 62–71.

19. Hojnacki D, Zamboni P, Lopez-Soriano A, Galleotti R, Menegatti E, Zivadinov R. Use of neck magnetic resonance venography, Doppler sonography and selective venography for diagnosis of chronic cerebrospinal venous insufficiency: a pilot study in multiple sclerosis patients and healthy controls. Int Angiol 2010; 29(2): 127–139.

20. Muhlberger D, Morandini L, Brenner E. An anatomical study of femoral vein valves near the saphenofemoral junction. J Vasc Surg 2008; 48(4): 994–999.

21. Vignes JR, Dagain A, Guerin J, Liguoro D. A hypothesis of cerebral venous system regulation based on a study of the junction between the cortical bridging veins and the superior sagittal sinus. Laboratory investigation. J Neurosurg 2007; 107(6): 1205–1210.

22. Dagain A, Vignes JR, Dulou R, Dutertre G, Delmas JM, Liguoro D. Junction between the great cerebral vein and the straight sinus: an anatomical, immunohistochemical, and ultrastructural study on 25 human brain cadaveric dissections. Clin Anat 2008; 21(5): 389–397.

23. Doepp F, Paul F, Valdueza JM, Schmierer K, Schreiber SJ. No cerebrocervical venous congestion in patients with multiple sclerosis. Ann Neurol 2010; 68(2): 173–183.

24. Lee BB, Bergan J, Gloviczki P, Laredo J, Loose DA, Zamboni P. Diagnosis and treatment of venous malformations Consensus Document of the International Union of Phlebology (IUP) – 2009. Int Angiol 2009; 28(6): 434–451.

25. Lee AB, Laredo J, Neville R. Embryological background of truncular venous malformation in the extracranial venous pathways as the cause of chronic cerebro spinal venous insufficiency. Int Angiol 2010; 29(2): 95–108.

26. Pascarella L, Schmid-Schonbein GW, Bergan J. An animal model of venous hypertension: the role of inflammation in venous valve failure. J Vasc Surg 2005; 41(2): 303–311.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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