Venous Collateral Blood Flow Assessed by Doppler Ultrasound after Unilateral Radical Neck Dissection

Abstract

Removal of the internal jugular vein (IJV) in unilateral radical neck dissection (rND) necessitates redirection of cerebrovenous blood to collateral pathways. If adaptation is insufficient, neurologic sequelae develop that are due to impaired venous drainage and increased intracranial pressure. The authors studied venous hemodynamic effects of unilateral rND using Doppler and duplex ultrasound in 17 patients. Blood flow velocities (BFVs) were recorded from the distal IJV (dIJV) and the vertebral vein (VV) before and 9 to 88 days after surgery. A preoperative compression test of the dIJV was performed to identify the side of dominant drainage. The BFV increased in the contralateral dIJV after right-sided rND (n = 10) by 111% (range, 50% to 320%), and after left-sided rND (n = 7) by 34% (range, 5% to 105%). In the contralateral VV, a rise of BFV by 75% was found. Our results confirm the role of the contralateral dIJV as the predominant collateral pathway. The VVs serve as an important additional major outflow. Doppler ultrasound may help to identify patients at risk of insufficient cerebrovenous drainage after rND.

Assessment of chronic cerebrospinal venous insufficiency among Iraqi multiple sclerosis patients by Echo color Doppler sonography

“…In correlating four distinct topographical patterns of 'venous obstruction' detected in MSpatients with clinical course, Zamboni et al stated a significant correlation (P<0.0001) between the pattern of bilateral IJV stenosis with both relapsing remitting Multiple Sclerosis (RRMS) (44%) and secondary progressive multiple sclerosis (SPMS) (56%) [5,11] which suggested that bilateral IJV stenosis predispose for the development of MS. Evidence for higher incidences of MS in patients after bilateral neck-dissection, which would match complete bilateral IJV occlusion, is, however, lacking [41]. In conclusion; this blind case control study does not support insufficient extra cranial venous flow in MS. Our study with other recent studies [37][38][39][40][41][42].…”

“…Evidence for higher incidences of MS in patients after bilateral neck-dissection, which would match complete bilateral IJV occlusion, is, however, lacking [41]. In conclusion; this blind case control study does not support insufficient extra cranial venous flow in MS. Our study with other recent studies [37][38][39][40][41][42]. All constitutes compelling evidence against a significant contribution of CCSVI in pathogenesis of MS.…”

Meta-Analysis of the Correlation Between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis

“…[13][14][15] An additional 3 studies were excluded because 0 patients fulfilled CCSVI criteria in both MS and control groups, and the OR could not be calculated. [16][17][18] The remaining 13 studies reported on 1879 total patients; 1141 with MS and 738 healthy matched controls ( Table 2). The OR was calculated for the 13 studies.…”

“…30 Radical neck dissection with ligation of the unilateral IJV may result in rare, transient neurologic symptoms. 16 However, unilateral and bilateral radical neck dissections are not a risk factor for the development of MS. 31 …”

Extrajugular pathways of human cerebral venous blood drainage assessed by duplex ultrasound

“…Such a route exists in the form of the anatomically complex vertebral venous system (1,7,8,16). Part of this system are the vertebral veins (VVs), which have been shown to serve as venous collaterals in cases of jugular flow obstruction (5,9). A recent ultrasound study of healthy volunteers demonstrated that the pattern of cerebral venous drainage changes, even under physiological conditions, depending on the body position (23).…”