Clinical Classification and Collateral Circulation in Chronic Cerebrospinal Venous Insufficiency

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.

Nonthrombotic internal jugular venous stenosis may facilitate cerebral venous thrombosis

“…Worthy of note is that IJVS is defined as the inner diameter at the stenosis segment less than 50% of the one at the adjacent normal segment, accompanied with abnormal collaterals. 8 , 9 …”

“…The former means the maximal cross‐sectional area of the collaterals <25% of the adjacent normal IJV, while the latter ≥25%. 8 , 9 An illustrated map concerning the compensatory patterns of the intra‐ and extracranial collaterals was shown as Figure 1 . Two experienced neuroradiologists who were blinded to our clinical data and study intention completed all neuroimaging assessments.…”

“…Worthy of note is that IJVS is defined as the inner diameter at the stenosis segment less than 50% of the one at the adjacent normal segment, accompanied with abnormal collaterals. 8,9 All patients were strictly selected with the following inclusion and exclusion criteria:…”

Numerical modeling of blood flow in the internal jugular vein with the use of computational fluid mechanics software

“…These authors also revealed an extensive collateral outflow through the vertebral venous system in patients presenting with jugular stenoses. 16 Examples of multiple sclerosis patients with stenoses located just below the jugular foramen are shown in Figure 1. Besides, some authors found a correlation between neurological pathology and an increased diameter of the IJV.…”

Management of Jugular Bulb Stenosis in Pediatric Vein of Galen Malformation: A Novel Management Paradigm

“…However, extrinsic causes of dural venous stenosis are well-described and the role of causative osseous narrowing must be considered [17, 18]. In fact, osseous compression accounts for nearly 80% of all extraluminal causes of IJV compression according to a recent report [19].…”