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CureIous wrote: Compression of the internal jugular vein by the transverse process of the atlas as the cause of cerebellar hemorrhage after supratentorial craniotomy.

Commentary
Auteur(s) / Author(s)
SEOANE E. (1) ; RHOTON A. L. (2) ; YONAS H. (Commentateur) (3) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) Department of Microsurgical Anatomy, University of Florida, Gainesville, Florida, ETATS-UNIS
(2) Department of Neurological Surgery, University of Florida, Gainesville, Florida, ETATS-UNIS
(3) Cerebrovascular Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, ETATS-UNIS
Résumé / Abstract

Abstract
Background

The cerebellar hemorrhage reported in numerous cases after supratentorial craniotomy has uniformly exhibited the characteristics of hemorrhage associated with venous infarction rather than arterial bleeding. The cause has remained obscure, although previous reports suggested that the cause may be obstruction of flow in the internal jugular vein immediately below the base of the skull.

Methods
The microsurgical anatomy of 36 internal jugular veins in the upper cervical region were defined in adult cadaveric specimens using 3–40× magnification with special attention to the relationship of the vein to the atlas.

Results
In every specimen, the posterior wall of the internal jugular vein rested against the transverse process of the atlas as the vein descended immediately below the jugular foramen. In 14 of 36 specimens, the transverse process indented the posterior wall of the vein, causing the vein to be slightly or moderately angulated as it descended across the anterior surface of the transverse process. Three veins were severely kinked as they descended across the transverse process of the atlas.

Conclusions
Obstruction of flow in the internal jugular vein at the site where the vein descends across the transverse process of the atlas is a likely cause of the venous hypertension that has resulted in the cerebellar hemorrhage reported in numerous cases after supratentorial craniotomy. An examination of the biomechanics of the region confirms that turning the head to the side opposite a supratentorial craniotomy and extending the neck, common practices with unilateral supratentorial craniotomy, further aggravates the angulation and obstruction of the internal jugular vein at the transverse process of C1 on the side ipsilateral to the craniotomy.

With all the discussion of the atlas and UCC in recent months, I wanted to bump up this research that Mark had discussed in his thread some time ago.

Authors proposed a link between IJV compression by the atlas and increased venous hypertension.

can somebody pls describe which position of head and neck should be avoided? I cannot imagine " turning the head to the side opposite a supratentorial craniotomy and extending the neck"

Supratentorial craniotomy is some sort of medical procedure. Let's see...it looks like it involves cutting into the skull to remove a brain tumor. After the procedure, the nurse positions the patient, and it may be that the patient is positioned in a way that further hinders jugular flow. Facing fully to the left or right hinders the flow in the opposite jugular. Extending the neck must hinder flow as well.

Patients who experience cerebellar hemorrhage after a supratentorial craniotomy seem to be more likely to have these jugular obstructions due to the atlas bone. The jugular obstructions caused venous hypertension, resulting in the hemorrhaging, at least according to the authors.

It makes it rather easy to believe that our own outflow obstructions also are causing venous hypertension, and that it is not a healthy condition.

thanks cece for posting this

Dr Arata was even talking about seeing impingement in the ijv at c1

This is part of the theory behind the treatment Emma is currently recieving for jaw misalignment along with atlas misalignment. We feel it's another part of the puzzle but is connected with CCSVI, which is why I posted my threads on this subforum.

In my case, it was NOT a question of the atlas C1 vertebrae being misaligned [out of correct position].

Rather there was a large bone growth [half-moon shaped] on the C1 that was compressing the IJV and the vagus nerve. This growth was removed by surgery. There was also scar tissue completely surrounding the IJV which was tethered to the vein. This was also removed in the same surgery.

Post-op the terrible "pins and needles" pain in my left hand completely disappeared, and this symptom improvement has been maintained.

I am going to have another surgery on the other side [right] later this month for the same reasons.

Donnchadh

Donnchadh wrote:In my case, it was NOT a question of the atlas C1 vertebrae being misaligned [out of correct position].

Rather there was a large bone growth [half-moon shaped] on the C1 that was compressing the IJV and the vagus nerve. This growth was removed by surgery. There was also scar tissue completely surrounding the IJV which was tethered to the vein. This was also removed in the same surgery.

Post-op the terrible "pins and needles" pain in my left hand completely disappeared, and this symptom improvement has been maintained.

I am going to hand another surgery on the other side later this month for the same reasons.

Donnchadh

This is really big - I'm not aware of any other people with CCSVI having had surgery on the upper neck, not on the vein itself but on bone or tissue compressing the vein. (Maybe Zamboni's team? They've done jugular grafting but not this as far as I know.)

That sounds like what Blossom needs to remove bone spurs. I call that Skeletal MS.

MS Cure Enigmas.net

Cece wrote:

Donnchadh wrote:In my case, it was NOT a question of the atlas C1 vertebrae being misaligned [out of correct position].

Rather there was a large bone growth [half-moon shaped] on the C1 that was compressing the IJV and the vagus nerve. This growth was removed by surgery. There was also scar tissue completely surrounding the IJV which was tethered to the vein. This was also removed in the same surgery.

Post-op the terrible "pins and needles" pain in my left hand completely disappeared, and this symptom improvement has been maintained.

I am going to have another surgery on the other side [right] later this month for the same reasons.

Donnchadh

This is really big - I'm not aware of any other people with CCSVI having had surgery on the upper neck, not on the vein itself but on bone or tissue compressing the vein. (Maybe Zamboni's team? They've done jugular grafting but not this as far as I know.)

The medical college where I had this procedure done at said it was the first time they tried this to treat that kind of condition. They were not aware of anyone else doing this.

Donnchadh

Donnchadh wrote:

Cece wrote:

Donnchadh wrote:In my case, it was NOT a question of the atlas C1 vertebrae being misaligned [out of correct position].

Rather there was a large bone growth [half-moon shaped] on the C1 that was compressing the IJV and the vagus nerve. This growth was removed by surgery. There was also scar tissue completely surrounding the IJV which was tethered to the vein. This was also removed in the same surgery.

Post-op the terrible "pins and needles" pain in my left hand completely disappeared, and this symptom improvement has been maintained.

I am going to have another surgery on the other side [right] later this month for the same reasons.

Donnchadh

This is really big - I'm not aware of any other people with CCSVI having had surgery on the upper neck, not on the vein itself but on bone or tissue compressing the vein. (Maybe Zamboni's team? They've done jugular grafting but not this as far as I know.)

The medical college where I had this procedure done at said it was the first time they tried this to treat that kind of condition. They were not aware of anyone else doing this.

Donnchadh

Donnchadh:

I'm delighted to see that your Doctors have the imagination and skill to do what seems obvious to me. Cece, I don't understand why it took so long to figure it out. I'm here going to reprint part my post for Dec 16, 2012 with a slight change.

"I believe Dr. Zamboni has discovered the problem – venous
blood reflux or CCSVI – but not the sole solution. Detoxification and
nutritional therapy coupled with circulation therapies and/or skeletal
adjustments may suffice to cure or control MS without
angioplasty. And sometimes surgery will be required to free a vein obstructed by bones, muscles or connective tissue...

SKELETAL MS: A misaligned skeletal, bone or dental structure can actually restrict the free
flow of cerebrospinal fluid which in turn can compress or impede venous blood
circulation. Structural problems can be either congenital or developmental in
origin (e.g. accidents.) Recent scientific studies have focused on the
interdependent dynamic of brain "fluids", the blood and the cerebrospinal fluid
(CBF) which bathes the Central Nervous System. Excess cerebrospinal fluid can
actually "compress" or limit blood circulation, hence the interest of
Chiropractors in adjusting the Atlas bone to assure proper CBF circulation. If
the problem is SKELETAL, angioplasty would not be appropriate. In this case it
is not a problem INSIDE the vein but OUTSIDE. Chiropractic, Osteopathic or
Dental adjustment may suffice to release the brain fluids flow leading to CURE
or CONTROL. And sometimes surgery will be required to free a vein obstructed
by bones, muscles, or connective tissue...

Again, to make a long story short, Dr. Zamboni has discovered the problem –
venous blood reflux or CCSVI – but not the sole solution. Detoxification and
nutritional therapy coupled with circulation therapies and/or skeletal adjustments may suffice.
And if surgery is required to free a vein obstructed by bone, muscle or connective tissue, angioplasty
would again be inappropriate.

We can now see that symptoms of paralysis require a thorough examination of the structure surrounding the central nervous system - bones, muscles, ligaments, cerebrospinal fluid, veins, arteries. Only then can a diagnosis and appropriate treatment be proposed. "

See MS Cure Enigmas.net

vesta wrote:
Donnchadh:

I'm delighted to see that your Doctors have the imagination and skill to do what seems obvious to me. Cece, I don't understand why it took so long to figure it out. I'm here going to reprint part my post for Dec 16, 2012 with a slight change.

"I believe Dr. Zamboni has discovered the problem – venous
blood reflux or CCSVI – but not the sole solution. Detoxification and
nutritional therapy coupled with circulation therapies and/or skeletal
adjustments may suffice to cure or control MS without
angioplasty. And sometimes surgery will be required to free a vein obstructed by bones, muscles or connective tissue...

SKELETAL MS: A misaligned skeletal, bone or dental structure can actually restrict the free
flow of cerebrospinal fluid which in turn can compress or impede venous blood
circulation. Structural problems can be either congenital or developmental in
origin (e.g. accidents.) Recent scientific studies have focused on the
interdependent dynamic of brain "fluids", the blood and the cerebrospinal fluid
(CBF) which bathes the Central Nervous System. Excess cerebrospinal fluid can
actually "compress" or limit blood circulation, hence the interest of
Chiropractors in adjusting the Atlas bone to assure proper CBF circulation. If
the problem is SKELETAL, angioplasty would not be appropriate. In this case it
is not a problem INSIDE the vein but OUTSIDE. Chiropractic, Osteopathic or
Dental adjustment may suffice to release the brain fluids flow leading to CURE
or CONTROL. And sometimes surgery will be required to free a vein obstructed
by bones, muscles, or connective tissue...

Again, to make a long story short, Dr. Zamboni has discovered the problem –
venous blood reflux or CCSVI – but not the sole solution. Detoxification and
nutritional therapy coupled with circulation therapies and/or skeletal adjustments may suffice.
And if surgery is required to free a vein obstructed by bone, muscle or connective tissue, angioplasty
would again be inappropriate.

We can now see that symptoms of paralysis require a thorough examination of the structure surrounding the central nervous system - bones, muscles, ligaments, cerebrospinal fluid, veins, arteries. Only then can a diagnosis and appropriate treatment be proposed. "

See MS Cure Enigmas.net

Indeed. This has turned out to be rather complicated. Perhaps in many cases, the problem is due to just a venous stenosis [probably genetic in origin].

With the advantage of hindsight, my initial gut feeling was correct. My "MS" was not the result of an infection, or autoimmune disorder but was the direct result of a terrible ladder accident and fall [about 20 feet down].

When venoplasty was previously attempted, no one had thought of external forces causing the venous stenosis and nerve impingement. And I had ascribed all my "MS" symptoms to circulatory problems as outlined by Dr. Zamboni. I now realize that IN ADDITION to CCSVI, the vagus nerve also plays an important role. It lies, after all, directly adjacent to the IJV and carotid artery. Some of my "MS" symptoms are due to CCSVI and some are caused by the vagus nerve [and their sub-branches!].

I must give credit to Dr. Arata who generously reviewed all my test images and reports and suggested the problem might lie with the styloid process pressing against the IJV. It was only by actually opening up my left Atlas C1 vertebrae and direct observation that it was discovered that a bone impingement was involved.
Turns out the the protruding bone was on the opposite side of the IJV, on the C1 vertebrae and not the styloid process [which was unremarkable]. But the general idea was correct-it was a bone external to the vein which had slowly grown over the years which eventually closed off the vein and pinched the vagus nerve. Without Dr. Arata's suggestion, we would have never thought to investigate this possibility.

While the C1 vertebrae could be misaligned and cause trouble, that was not the underlying cause in my case.
Chiropractic manipulation could not remove a bone growth. Diet has nothing to do to this situation.

There is definitely a role left for venoplasty in my case. Just by removing external constrictions on the IJV doesn't necessarily mean that it will automatically and spontaneously reopen to normal dimensions. There is internal calcification left which still needs to be broken up.

After my next surgery, we will have to wait for my neck to heal up and then do the venoplasty on the right hand side. Hopefully, with all the external venous problems removed it will be a straight forward procedure.

I am most fortunate to have a first rate neurosurgeon willing to take on a puzzling case and with the patience of a saint to deal with an Jungian INTJ personality.

Donnchadh

What a story, D!
Thank you for sharing your diagnostic and treatment process with all of us.
Any chance someone in your treating/diagnostic team can write up a paper for a journal submission?
Getting these cases documented and shared can only be of service to others who may have similar issues, and help us keep CCSVI research moving forward.
http://ccsviinms.blogspot.com/2013/10/m ... rward.html
Hope so!!
best,
cheer

cheerleader wrote:What a story, D!
Thank you for sharing your diagnostic and treatment process with all of us.
Any chance someone in your treating/diagnostic team can write up a paper for a journal submission?
Getting these cases documented and shared can only be of service to others who may have similar issues, and help us keep CCSVI research moving forward.
http://ccsviinms.blogspot.com/2013/10/m ... rward.html
Hope so!!
best,
cheer

I [only half-jokingly] refer to myself as "lab rat No. 1" because I am well aware that this is new territory. While I was recovering in the ICU, there were a number of doctors visiting me because of the novelty of this procedure [it is part of a major medical college].

The neurosurgeon is actually somewhat sceptical of CCSVI until there is more research and papers published.
But he does stay on top of the topic and has attended international conferences on this topic.

Hopefully, my case will be ultimately successful and serve as a guide-at least for patients with primary progressive MS due to accidental injuries.

He is very willing to help others but has asked me not to reveal his name or or that of the medical college until after my course of treatments has been completed and they have had an opportunity to evaluate the results.

For my part, I have given my permission for him to discuss my case with other Doctors. And coming here to ThisIsMS is my way of spreading the news. When the Doctor OK's it, I will give out his name.

I am convinced that the majority of venous disorders have some sort of genetic origin, but a small percentage are due to accidental injury to otherwise healthy veins. And many of these cases tend to be of progressive nature.

In the meantime, I am setting a record for the number of venoplasty attempts-it's at seven now and I will need at least one more after the neck procedure. How the stenosis in the left sigmoid sinus is going to be dealt with has been deferred for now-that's going to be difficult. A stent? Like Linda Lousay had done?

Donnchadh

Donnchadh wrote:I am convinced that the majority of venous disorders have some sort of genetic origin, but a small percentage are due to accidental injury to otherwise healthy veins. And many of these cases tend to be of progressive nature.

If one of the future lab rats could be someone who had no jugular intraluminal stenoses and only the accident-related external compression, then that would help establish this.
Exciting times.

Cece wrote:

Donnchadh wrote:I am convinced that the majority of venous disorders have some sort of genetic origin, but a small percentage are due to accidental injury to otherwise healthy veins. And many of these cases tend to be of progressive nature.

If one of the future lab rats could be someone who had no jugular intraluminal stenoses and only the accident-related external compression, then that would help establish this.
The future looks bright.

My thinking is that the accidental injury is what caused the venous stenosis. On my lower IJV-both sides-there were damaged valves which have been successfully opened by venoplasty, and they have stayed opened post-op. There were no bones compressing against these sites.

My accident was kind of a "whip-lash" on steroids. This accident also caused a herniated disc at the C5-C6 level which was successfully treated by the same neurosurgeon. He considered that procedure "routine" !!!

I would be very interested in hearing from other people who had accidents PRIOR to the first manifestation of MS symptoms.

Donnchadh