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Open Access Highly Accessed Debate

Potential involvement of the extracranial venous system in central nervous system disorders and aging

Robert Zivadinov12* and Chih-Ping Chung34

Author Affiliations

1 Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA

2 MR Imaging Clinical Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St., Buffalo, NY 14203, USA

3 Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan

4 Department of Neurology, National Yang Ming University of Medicine, Taipei, Taiwan

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BMC Medicine 2013, 11:260  doi:10.1186/1741-7015-11-260

Published: 17 December 2013

Abstract

Background

The role of the extracranial venous system in the pathology of central nervous system (CNS) disorders and aging is largely unknown. It is acknowledged that the development of the venous system is subject to many variations and that these variations do not necessarily represent pathological findings. The idea has been changing with regards to the extracranial venous system.

Discussion

A range of extracranial venous abnormalities have recently been reported, which could be classified as structural/morphological, hemodynamic/functional and those determined only by the composite criteria and use of multimodal imaging. The presence of these abnormalities usually disrupts normal blood flow and is associated with the development of prominent collateral circulation. The etiology of these abnormalities may be related to embryologic developmental arrest, aging or other comorbidities. Several CNS disorders have been linked to the presence and severity of jugular venous reflux. Another composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI) was recently introduced. CCSVI is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes that may interfere with normal venous outflow.

Summary

Additional research is needed to better define the role of the extracranial venous system in relation to CNS disorders and aging. The use of endovascular treatment for the correction of these extracranial venous abnormalities should be discouraged, until potential benefit is demonstrated in properly-designed, blinded, randomized and controlled clinical trials.

Please see related editorial: http://www.biomedcentral.com/1741-7015/11/259 webcite.

Keywords:
Jugular vein reflux; CCSVI; Anatomy; Etiology; Pathophysiology; Classification; Diagnosis; CNS disorders; Aging; Multiple sclerosis; Compensatory mechanism