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costumenastional wrote:?I am really sorry you would think something like that for me doctor. Forgive me but i ll stick with what i wrote simply because i mean it.

A well-recognized feature of the jugular and vertebral venous systems in the neck is the way in which they respond to changes in body orientation: during upright position the vertebral plexus takes over nearly all of the jugular venous outflow,5 suggesting that a great deal of adaptability and autoregulation also exist in the venous neck drainage system. The interesting correlation between jugular venous obstruction and demyelinating disease found by Zamboni et al.1,2,8 recently, has therefore come as a surprise because the cerebral venous system appears, at least in theory, to cope quite well with low flow. Neck surgeons have for a long time occluded the jugular veins during radical neck surgery to treat cancer and they have largely succeeded without seeing significant hemodynamic changes of the intracranial pressure doing each side’s ligation in stages. Uneventful outcomes exist even in cases of simultaneous bilateral jugular ligation.9 To the best of the authors’ knowledge there are no reports of clinical or neuroimaging findings resembling those of demyelinating disease after those procedures. Similarly, we have not seen imaging changes resembling MS in patients suffering jugular thrombosis from central lines inserted in intensive care unit (ICU) patients. Put simply, the vertebral venous system appears to compensate efficiently for impaired flow in the jugular veins.


If we follow the venous system caudally, parallel to the jugular system, the drainage of the posterior neck and cervical spine takes place through a complex and rich vertebral plexus that eventually proceeds to the brachiocephalic veins, one on each side. These large trunks converge into the superior vena cava (SVC). The azygos vein joins the superior vena cava before the latter reaches the right atrium.10 The upper third of the thoracic spine drainage is through the superior intercostal veins that flow into the azygos and left hemiazygos in 75% of cases. In the remainder the superior intercostal veins end in the brachiocephalic trunks. The mid, lower thoracic and lumbosacral spine venous drainage is largely shared by the lumbar, azygos, and sacral veins. Hence, the azygos system is a back up venous route for the vena cava arrangement,11 in cases of vena cava obstruction. It would be surprising if insufficiency of a collateral system such as the azygos were enough to alter the well-adjusted spinal venous homeostasis and produce the spinal manifestations of MS.

In well-documented cases of venous hypertension created by the presence of a high flow lesion such as dural Arteriovenous (AV) fistula, any spinal cord lesions present on MRI have very different characteristics from a demyelinating plaque. The former feature is a significant edematous swelling involving the whole segment of the spinal cord and not a single lesion in the posterior columns.

TMrox wrote:Dear Dr Sclafani,

Thanks so much for all your enthusiasm, knowledge and the hard work you have vested in us. I wish there were more docs like you.

I have a question regarding the article below. Do the occlusion of jugular veins to treat cancer patients really resemble anything like having CCSVI?

Many thanks,
Rox

In well-documented cases of venous hypertension created by the presence of a high flow lesion such as dural Arteriovenous (AV) fistula, any spinal cord lesions present on MRI have very different characteristics from a demyelinating plaque. The former feature is a significant edematous swelling involving the whole segment of the spinal cord and not a single lesion in the posterior columns.

siduri wrote:Hi Dr. Sclafani - I am still feeling shock & awe that after 30 years of losing ground, drawing on hope, denial, and fantasy, I now feel empowered! I’ve never before seen such intellectual curiosity, professional passion, and human compassion directed at something that could help ME. Thank you so much for bringing all of your beautiful brains together.

I'm on waiting lists for you & Dr. Siskin, and since I'm coming from Alaska, am wondering about follow up care. If I have treatment with one dr and find someone closer that could do follow up care, is there a feeling of ownership - stay out of another drs territority - in this field? Don't take me off your list! I'll fly to NY every 3 months if I have to, but I haven't seen this question discussed before.

TMrox wrote:Dear Dr Sclafani,

Sorry to ask two questions in one day.

Here is a 1969 article on occluded azygous vein and the value of azygography to evaluate the effectiveness of radiation therapy for cancer treatment. Have you seen this article?

http://www.ajronline.org/cgi/reprint/105/1/83.pdf

I have no idea what the article means by opening a previously occluded azygous. How did the docs open the occluded vein back in 1969? Is this kind of obstructions what we we are seeing in CCSVI?

Sorry if it this turns completely irrelevant.

Rox

drsclafani wrote:yes, i have thought about it too. this would make a good novel, perhaps even a movie. cece, interested?

TMrox wrote:Dear Dr Sclafani,

As always I enjoyed reading your answers. I’m looking forward to reading your reply in print to the endovascular venous procedure article. We need more dialogue in print among docs.

I wonder how the cancer patients of the 1969 article felt with their azygous vein occluded by a tumour. I now understand that it is a different kind of occlusion to the one we have with CCSVI, but still curious if they shared any of the CCSVI symptoms. Well I might never know that answer so I’ll instead focus on the unfolding CCSVI research.

Many thanks,
Rox