Fisiologia e fisiopatologia della insufficienza venosa cerebrospinale: proposta di nuovi criteri diagnostici

Background: The physiological meccanisms thath influence the venous drainage of the extracranial venous system could be investigated by ecoDoppler sonography. The alterations of phsyological meccanism of extracranial venous drainage rappresents the physiopathological substract of CCSVI. Patients with SM have shown to have a higher prevalence of CCSVI. Objective: to study the physiology and physiopatology of the venous drainage trough the extracranial venous system using ecoDoppler sonography and to propose new criteria to define a condition of CCSVI Methods: Extracranial ECD were carried out in 126 enrolled subjects (63 healthy control and 63 subjects with multiple sclerosis matched by gender and age). Prevalence rates for CCSVI were calculated using Zamboni criteria and using two new criteria (Giugular Respiratory Index and Giugular Subclavian Index) based on physiology of extracranial venous drainage. Results: CCSVI prevalence using Zamboni criteria was 63% in SM and 44% in HC (P 0,03*), the prevalence using new criteria was 44% and 36% in SM ( respectively for GRI and GSI) and 9% and 3% in HC (P <0,0001 ****). Conclusions: our findings are consistent with an increased prevalence of CCSVI in MS with modest sensitivity and specificity using Zamboni criteria and with high specificity using new criteria (Giugular Respiratory Index a nd Giugular Subclavian Index). Our findings point against CCSVI having a primary causative role in the development of MS.