The controversy on chronic cerebrospinal venous insufficiency

Zamboni, Paolo; Menegatti, Erica; Occhionorelli, Savino; Salvi, Fabrizio

doi:10.4081/vl.2013.e14

Cited by 16 publications

(17 citation statements)

References 51 publications

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“…Other relevant age-related parameters to regulate the pressure and flow rate in the 1-D part of the model are total blood volume (TBV), cerebral blood volume (CBV), and cardiac volume output ratio index (CBV/CO) [2]. The CO is calculated by multiplying HR by the difference between end-diastolic volume and end-systolic volume [17]. Since the ascending aorta was not in the selected region of our study, we were not able to calculate the cardiac volume output ratio index.…”

Section: Adjusting the Physiologic Parametersmentioning

confidence: 99%

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Paediatric haemodynamic modelling: development and experimental validation using quantitative flow MRI

et al. 2020

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Background: Congenital vascular disease is one of the leading causes of death in paediatric age. Despite the importance of paediatric haemodynamics, large investigations have been devoted to the evaluation of circulation in adults. The novelty of this study consists in the development of a well calibrated mathematical model of cardiovascular circulation in paediatric subjects. To reach the purpose, a model for adult circulation was modified and recalibrated with experimental data and literature from children to be able to calculate the flow rates and pressures in the brain and neck. Methods: The haemodynamic model simulates the 76 main arteries, together with the main veins in brain and neck. A proper magnetic resonance imaging (MRI) dataset of 29 volunteers aged 12 ± 5 years (mean ± standard deviation) was used to extract age-dependent physiological and clinical parameters such as heart rate, flow rate, vessel cross section area, and blood pressure. The computational model was calibrated using such experimental data. The paediatric and adult model results were compared. Results: Increase of the vessels stiffness due to aging contributes to a flow rate decrease while blood pressure increases. In accordance, our simulation results show about 16% decrease in mean pressure of internal jugular vein in paediatric rather than adult subjects. The model outcomes indicated about 88% correlation with MRI data. Conclusions: The mathematical model simulates the paediatric head and neck blood circulation. The model provides detailed information of human haemodynamics including arterial and venous network to study both paediatric and adult blood circulation.

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Section: Adjusting the Physiologic Parametersmentioning

confidence: 99%

“…Each of the two IJVs is conventionally subdivided into three segments (J3, J2, and J1, from the head to the heart) and its cross-sectional area increases along the same direction [15,16]. Due to their large cross-sectional area, IJVs are the main blood outflow pathway from the brain in the supine position [17].…”

Section: Introductionmentioning

confidence: 99%

Paediatric haemodynamic modelling: development and experimental validation using quantitative flow MRI

et al. 2020

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“…Moreover, this argument has openly split medical opinions and shaken a worldwide population of patients affected with multiple sclerosis (MS). 1 All this turmoil started a few years ago, in 2007, when Prof. Paolo Zamboni first presented his paper regarding the Big Idea 2 that gave fire to the fuse and shortly after exploded with shattering effects inside medical scientific world. [3][4][5][6] In past, we gave our contribution with two papers, 7,8 with the purpose to realize the presence of CCSVI in MS affected patients through Duplex exams.…”

Section: Introductionmentioning

confidence: 99%

May symptoms of chronic cerebrospinal venous insufficiency be improved by venous angioplasty? An independent 4-year follow up on 366 cases

Bavera

2015

Veins and Lymphatics

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The aim of the study was to collect results from 366 chronic cerebrospinal venous insufficiency (CCSVI) affected patients that were regularly Duplex controlled after having received vein angioplasty following diagnosis for CCSVI. The procedures were all performed in the same Centre and same equipment. The patients were divided into three groups according to the attributed severity of the associated multiple sclerosis: 264 relapse-remitting (RR) (72%): 179 females (67.8%) and 85 (32.2%) males; 62 secondary progressive (17%): 37 (59.7%) females and 25 (40.3%) males; 40 primary progressive (11%): 22 (55%) females and 18 (45%) males. A data base revealed eleven most frequent disturbs and symptoms, together with working capacities, and was kept up-todate at every Duplex control aiming to establish a novel rapid CCSVI symptoms questionnaire assessment in 4 years follow up. The symptoms were: diplopia, fatigue, headache, upper limb numbness/mobility, lower limb numbness/mobility, thermic sensibility, bladder control, balance coordination, quality of sleep, vertigo, mind concentration.Results, as follows, appear to be significantly good in the RR group, also the biggest one. upper limb numbness and mobility in 20/24 (83.3%) (P=0.0002); lower limb numbness and mobility 13/15 (86.7%) (P=0.0087); thermic sensibility 3/4 (75%) [P: not significant (n.s.)]; bladder control 2/3 (66.6%) (P: n.s.).In contrast in the progressive cases results are quite different where, nevertheless, some useful considerations were collected and statistically significant, too.In addition, venous angioplasty appears to be safe, side effects were observed only in seven patients (0.19%) that grew a monolateral Jugular thrombosis but still were regularly controlled and above all did not suffer worsening of the disease. Finally, the overwhelming percutaneous transluminal angioplasty results in the RR group lead to say that the correct criteria should be the sooner the better.

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“…This may have a great impact toward a deeper understanding of pathological disorders involving abnormalities of the cerebral venous outflow. In perspective, it may be used to assess which alterations in the extracranial venous outflow may be in relation with central nervous system disorders and aging (6,10,24,40,42).…”

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confidence: 99%

A new hemodynamic model for the study of cerebral venous outflow

Gadda

Taibi

Sisini

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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We developed a mathematical model of the cerebral venous outflow for the simulation of the average blood flows and pressures in the main drainage vessels of the brain. The main features of the model are that it includes a validated model for the simulation of the intracranial circulation and it accounts for the dependence of the hydraulic properties of the jugular veins with respect to the gravity field, which makes it an useful tool for the study of the correlations between extracranial blood redistributions and changes in the intracranial environment. The model is able to simulate the average pressures and flows in different points of the jugular ducts, taking into account the amount of blood coming from the anastomotic connections; simulate how the blood redistribution due to change of posture affects flows and pressures in specific points of the system; and simulate redistributions due to stenotic patterns. Sensitivity analysis to check the robustness of the model was performed. The model reproduces average physiologic behavior of the jugular, vertebral, and cerebral ducts in terms of pressures and flows. In fact, jugular flow drops from ϳ11.7 to ϳ1.4 ml/s in the passage from supine to standing. At the same time, vertebral flow increases from 0.8 to 3.4 ml/s, while cerebral blood flow, venous sinuses pressure, and intracranial pressure are constant around the average value of 12.5 ml/s, 6 mmHg, and 10 mmHg, respectively. All these values are in agreement with literature data. mathematical modeling; cerebral outflow; posture dependence; jugular veins collapse; collateral routes THE EXTRACRANIAL VENOUS SYSTEM represents an important determinant of the brain circulation, but its role in the pathology of the central nervous system is not fully understood yet (4,26). It is recognized that, in supine position, the jugular veins represent the main outflow route for the cerebral circulation (2,6,25,36,38), being able to carry most of blood flow from the brain and from other extracerebral territories (ϳ700 -720 ml/ min; Refs. 27, 33) with respect to a cerebral blood inflow of ϳ750 ml/min (45). However, the jugular venous system exhibits important flow limitation during upright posture changes, because the jugular veins tend to collapse as a consequence of the decrease of transmural pressure due to the gravitational field, causing a significant increase in resistance (3,7,12,14,26). In the absence of other routes for extracranial outflow, this flow limitation would have dramatic effects on the cerebral circulation, since, apart from brief transient time intervals, the average cranial arterial inflow is expected to be equal to the cranial venous outflow for the mass preservation.As a consequence, large attention has been devoted to the venous circulation in the upright state, in an effort to understand which alternative routes can carry the brain venous outflow. It has long been postulated that the vertebral venous system may provide an important alternative route for venous outflow when standing or sitting; this was f...

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The controversy on chronic cerebrospinal venous insufficiency

Cited by 16 publications

References 51 publications

Paediatric haemodynamic modelling: development and experimental validation using quantitative flow MRI

Paediatric haemodynamic modelling: development and experimental validation using quantitative flow MRI

May symptoms of chronic cerebrospinal venous insufficiency be improved by venous angioplasty? An independent 4-year follow up on 366 cases

A new hemodynamic model for the study of cerebral venous outflow

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