Chronic cerebrospinal venous insufficiency (CCSVI) was recently proposed as a contributing factor in the pathology of multiple sclerosis. This concept has gained remarkable attention, partly because endovascular neurointervention has been suggested as a treatment strategy. This review summarizes available evidence and provides a critical analysis of the published data. Currently, there is inconclusive evidence to support CCSVI as an etiological factor in patients with multiple sclerosis. Endovascular procedures should not be undertaken outside of controlled clinical trials.
Al-OmariM.H.RousanL.A. (2010) Internal jugular vein morphology and hemodynamics in patients with multiple sclerosis. Int Angiol29: 115–120.
2.
AlonsoA.HernanM.A. (2008) Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology71: 129–135.
3.
BaracchiniC.PeriniP.CalabreseM.CausinF.RinaldiF.GalloP. (2011) No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset. Ann Neurol69: 90–99.
4.
ChungC.P.HsuH.Y.ChaoA.C.ChangF.C.ShengW.Y.HuH.H. (2006) Detection of intracranial venous reflux in patients of transient global amnesia. Neurology66: 1873–1877.
5.
ChungC.P.HsuH.Y.ChaoA.C.ShengW.Y.SoongB.W.HuH.H. (2007) Transient global amnesia: cerebral venous outflow impairment-insight from the abnormal flow patterns of the internal jugular vein. Ultrasound Med Biol33: 1727–1735.
6.
ChungY.A.JeongJ.YangD.W.KangB.J.KimS.H.ChungS.K. (2009) A Tc-99 m spect study of regional cerebral blood flow in patients with transient global amnesia. Neuroimage47: 50–55.
7.
ConfavreuxC.HutchinsonM.HoursM.M.Cortinovis-TourniaireP.MoreauT. (1998) Rate of pregnancy-related relapse in multiple sclerosis pregnancy in multiple sclerosis group. N Engl J Med339: 285–291.
8.
DoeppF.PaulF.ValduezaJ.M.SchmiererK.SchreiberS.J. (2010) No cerebrocervical venous congestion in patients with multiple sclerosis. Ann Neurol68: 173–183.
9.
DollR.HillA.B. (1950) Smoking and carcinoma of the lung: Preliminary report. Br Med J2: 739–748.
10.
HaackeE.M.GarbernJ.MiaoY.HabibC.LiuM. (2010) Iron stores and cerebral veins in ms studied by susceptibility weighted imaging. Int Angiol29: 149–157.
11.
HillA.B. (1965) The environment and disease: Association or causation?Proc R Soc Med58: 295–300.
12.
KrogiasC.SchroderA.WiendlH.HohlfeldR.GoldR. (2010) [‘Chronic cerebrospinal venous insufficiency’ and multiple sclerosis: Critical analysis and first observation in an unselected cohort of MS patients]. Nervenarzt81: 740–746.
13.
KurtzkeJ.F. (1975) A reassessment of the distribution of multiple sclerosis. Acta Neurol Scand51: 137–157.
14.
LucchinettiC.BruckW.ParisiJ.ScheithauerB.RodriguezM.LassmannH. (2000) Heterogeneity of multiple sclerosis lesions: Implications for the pathogenesis of demyelination. Ann Neurol47: 707–717.
15.
LucchinettiC.F.BruckW.RodriguezM.LassmannH. (1996) Distinct patterns of multiple sclerosis pathology indicates heterogeneity on pathogenesis. Brain Pathol6: 259–274.
16.
MayerC.A.PfeilschifterW.LorenzM.W.NedelmannM.BechmannI.SteinmetzH. (2011) The perfect crime? CCSVI not leaving a trace in MS. J Neurol Neurosurg Psychiatryin press.
17.
NielsenT.R.PedersenM.RostgaardK.FrischM.HjalgrimH. (2007) Correlations between Epstein-Barr virus antibody levels and risk factors for multiple sclerosis in healthy individuals. Mult Scler13: 420–423.
18.
RosatiG. (2001) The prevalence of multiple sclerosis in the world: An update. Neurol Sci22: 117–139.
19.
SakaiT.KondoM.TomimotoH. (2010) [Three patients with transient global amnesia following an increased venous pressure: A study using 3.0 tesla diffusion-weighted magnetic resonance imaging]. Rinsho Shinkeigaku50: 473–477.
20.
SamsonK. (2010) Experimental multiple sclerosis vascular shunting procedure halted at Stanford. Ann Neurol67: A13–A15.
21.
SanderD.WinbeckK.EtgenT.KnappR.KlingelhoferJ.ConradB. (2000) Disturbance of venous flow patterns in patients with transient global amnesia. Lancet356: 1982–1984.
SchreiberS.J.DoeppF.KlingebielR.ValduezaJ.M. (2005) Internal jugular vein valve incompetence and intracranial venous anatomy in transient global amnesia. J Neurol Neurosurg Psychiatry76: 509–513.
24.
Soilu-HanninenM.LaaksonenM.LaitinenI.EralinnaJ.P.LiliusE.M.MononenI. (2008) A longitudinal study of serum 25-hydroxyvitamin d and intact parathyroid hormone levels indicate the importance of vitamin d and calcium homeostasis regulation in multiple sclerosis. J Neurol Neurosurg Psychiatry79: 152–157.
25.
SundstromP.WahlinA.AmbarkiK.BirganderR.EklundA.MalmJ. (2010) Venous and cerebrospinal fluid flow in multiple sclerosis: A case-control study. Ann Neurol68: 255–259.
26.
VukusicS.HutchinsonM.HoursM.MoreauT.Cortinovis-TourniaireP.AdeleineP. (2004) Pregnancy and multiple sclerosis (the Prims Study): Clinical predictors of post-partum relapse. Brain127: 1353–1360.
27.
WattjesM.P.Van OostenB.W.De GraafW.L.SeewannA.BotJ.C.Van Den BergR. (2010) No association of abnormal cranial venous drainage with multiple sclerosis: A magnetic resonance venography and flow-quantification study. J Neurol Neurosurg Psychiatryin press.
28.
WorthingtonV.KillesteinJ.EikelenboomM.J.TeunissenC.E.BarkhofF.PolmanC.H. (2010) Normal CSF ferritin levels in MS suggest against etiologic role of chronic venous insufficiency. Neurology75: 1617–1622.
29.
YamoutB.HerlopianA.IssaZ.HabibR.H.FawazA.SalameJ. (2010) Extracranial venous stenosis is an unlikely cause of multiple sclerosis. Mult Scler16: 1341–1348.
30.
ZamboniP. (2006) The big idea: Iron-dependent inflammation in venous disease and proposed parallels in multiple sclerosis. J R Soc Med99: 589–593.
31.
ZamboniP.GaleottiR.MenegattiE.MalagoniA.M.GianesiniS.BartolomeiI. (2009a) A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency. J Vasc Surg501348–1358 e1341–e1343.
32.
ZamboniP.GaleottiR.MenegattiE.MalagoniA.M.TacconiG.Dall'araS. (2009b) Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry80: 392–399.
33.
ZamboniP.MenegattiE.GaleottiR.MalagoniA.M.TacconiG.Dall'araS. (2009c) The value of cerebral Doppler venous haemodynamics in the assessment of multiple sclerosis. J Neurol Sci282: 21–27.
34.
ZamboniP.MenegattiE.Weinstock-GuttmanB.SchirdaC.CoxJ.L.MalagoniA.M. (2009d) The severity of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis is related to altered cerebrospinal fluid dynamics. Funct Neurol24: 133–138.
35.
ZivadinovR.Lopez-SorianoA.Weinstock-GuttmanB.SchirdaC.V.MagnanoC.R.DolicK. (2011) Use of MR venography for characterization of the extracranial venous system in patients with multiple sclerosis and healthy control subjects. Radiology258: 562–570.
36.
ZivadinovR.SchirdaC.DwyerM.G. HaackeM.E.Weinstock-GuttmanB.MenegattiE. (2010) Chronic cerebrospinal venous insufficiency and iron deposition on susceptibility-weighted imaging in patients with multiple sclerosis: A pilot case-control study. Int Angiol29: 158–175.