Zamboni: Review of the Brave Dreams trial

[frodo]

Extracranial Veins in Multiple Sclerosis: Is There a Role for Vascular Surgery?

https://www.ejves.com/article/S1078-588 ... 3/fulltext

Conclusions and Perspectives

From a pathophysiological point of view the post hoc analysis reported above suggests a role of impaired extracranial venous flow in lesion development in patients with MS, as well as the probability of significant advantages when the brain outflow is restored. This finding continues to support the CCSVI hypothesis and the contribution of the jugular flow to cerebral inflammation.

CCSVI still represents a new hypothesis to attempt to explain the pathogenesis of MS, but has not ultimately led to a viable minimally invasive surgical treatment option for all patients with this condition.1, 2 CCSVI presentation is complex, mostly with compressions associated with long endoluminal obstacles, where, as reported above, PTA is safe but often ineffective. We also know that the improvement of jugular vein flow achieved by open surgery in the vast majority of MS patients correlated with improved cerebral perfusion and decreased brain ventricle volume.4 But, of course, an open surgery option cannot be offered widely. Alternatively, of particular interest for the vascular surgeon and/or the interventional radiologist would be further technological development of venous stents. The latter would take into account the compliance properties of the vein wall, which, at the level of the internal jugular vein, causes a sixfold reduction in the cross sectional area when passing from the supine position to the sitting position.5

CCSVI created a great deal of controversy in the neurological community, but undoubtedly contributed to a better understanding of the function of the extracranial venous system.6

It has been demonstrated how extracranial venous function might influence brain perfusion, cerebrospinal fluid (CSF) flow, and CSF absorption.4, 7, 8 In other independent studies, the extracranial venous system was also found to be associated with other neurodegenerative conditions including Parkinson's, Alzheimer's, and Meniere's diseases, suggesting the need for further investigations.9, 10, 11, 12 Vascular science is beginning to bridge the knowledge gap between the extracranial veins and the brain.

This development of vascular studies in the field of neurodegeneration is to be considered of extraordinary interest. In my opinion the cerebral vascular system plays a prominent role in the understanding of these pathologies, and the main extracranial vessels and vascular surgeons cannot be kept out of the game.