Clinical Classification and Collateral Circulation in Chronic Cerebrospinal Venous Insufficiency.

Zhongao Wang,Yuchuan Ding,Xunming Ji,Chaobo Bai,Jiayue Ding,Ran Meng

doi:10.3389/fneur.2020.00913

Abstract

Background: As an indispensable part of the cerebral venous system, the extracranial cerebrospinal venous system is not fully recognized. This study aimed to analyze the clinical classification and imaging characteristics of chronic cerebrospinal venous insufficiency (CCSVI) quantitatively.Methods: A total of 128 patients, who were diagnosed as CCSVI by jugular ultrasound and contrast-enhanced magnetic resonance venography (CE-MRV), were enrolled from May 2018 through May 2019. For the patients with possible extraluminal compression, computed tomography venography (CTV) was applied to estimate the degree of internal jugular venous stenosis (IJVS) and rank the vertebral venous collateral circulation.Results: The causes of extraluminal compression induced IJVS included osseous compression (78.95%), carotid artery (24.21%), sternocleidomastoid muscle (5.79%), swollen lymph node (1.05%), and unknown reasons (5.26%). The subtypes of non-compression CCSVI included the high jugular bulb (77.27%), fenestration of the internal jugular vein (IJV) (7.27%), internal jugular phlebectasia (2.73%), tortuous IJV (0.91%), IJV thrombosis (14.55%), and elongated venous valves with/without erythrocyte aggregation (13.64%). For extraluminal compression induced IJVS, the ratio of severe vertebral venous expansion was higher in the severe IJVS group than that in the mild IJVS group (p < 0.001). The IJVS degree was higher in the severe vertebral venous expansion group than in the mild vertebral venous expansion group (p < 0.001).Conclusions: A multimodal diagnostic system is necessary to improve the diagnostic accuracy of CCSVI. The vertebral venous system is an important collateral circulation for CCSVI, which may be a promising indicator for evaluating IJVS degree.

Highlights

The cerebrospinal venous system is a crucial channel for the cerebral venous outflow, which plays an important role in transporting metabolic wastes, collecting cerebral spinal fluid, and regulating intracranial pressure
We aimed to describe the clinical classification of chronic cerebrospinal venous insufficiency (CCSVI) systematically with a multimodal diagnostic system, and further estimate the correlation between internal jugular venous stenosis (IJVS) and collateral circulation quantitatively with a computed tomography venography (CTV) scan
Patients were enrolled in this study according to the following inclusion criteria: (a) age from 18 to 80 years; (b) internal jugular anomalies confirmed by contrast-enhanced magnetic resonance venography (CE-MRV)/CTV/jugular ultrasound; (c) with non-focal neurological deficits; and (d) with abnormally dilated paraspinal collateral veins

Summary

Introduction

The cerebrospinal venous system is a crucial channel for the cerebral venous outflow, which plays an important role in transporting metabolic wastes, collecting cerebral spinal fluid, and regulating intracranial pressure. Classification and Collateral in CCSVI venous system, the disturbance of the extracranial cerebrospinal venous system is far from fully recognized by the non-specific clinical presentations and inadequate awareness [1, 2]. Our previous study showed that CCSVI might be relevant to an independent disease entity, with non-focal neurological symptoms such as sleep disturbance, tinnitus, head noise, dizziness, and headache whereas without specific clinical signs and imaging findings in the brain, misdiagnosis or missed diagnosis is common. As an indispensable part of the cerebral venous system, the extracranial cerebrospinal venous system is not fully recognized. This study aimed to analyze the clinical classification and imaging characteristics of chronic cerebrospinal venous insufficiency (CCSVI) quantitatively

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