Fixing the jugular flow reduces ventricle volume and improves brain perfusion

Area of Science:

• Neurology
• Vascular Surgery
• Medical Imaging

Background:

• Increased ventricle volume and brain hypoperfusion are associated with neurodegeneration.
• Chronic cerebrospinal venous insufficiency (CCVI) can lead to restricted jugular flow, impacting cerebral hemodynamics.

Purpose of the Study:

• To investigate whether surgical restoration of jugular venous flow can reduce brain ventricle volume and improve cerebral perfusion in patients with CCVI.
• To assess the impact of improved venous pressure gradient on cerebrospinal fluid reabsorption.

Main Methods:

• Utilized echocardiography with color Doppler (ECD), magnetic resonance venography, and SPECT-CT to assess jugular flow and brain parameters.
• Measured cerebral ventricle volume and brain perfusion before and after surgical intervention (endophlebectomy and vein patch angioplasty).
• Compared outcomes in treated patients with a control group not undergoing surgery.

Main Results:

• Surgical restoration significantly improved internal jugular vein flow (collateral flow index reduced from 70% to 30%, P < .0003).
• Treated patients showed a significant decrease in ventricle volume (34 ± 14 cm³ to 31 ± 13 cm³, P < .01), particularly in the relapsing-remitting multiple sclerosis subgroup.
• Cerebral perfusion improved in the surgical group compared to controls, especially in the occipital and parietal regions of the RR subgroup.

Conclusions:

• Restoring jugular venous flow in CCVI patients can significantly reduce brain ventricle volume and enhance cerebral perfusion.
• The positive effects are more pronounced in patients with earlier stages of neurodegenerative disease, such as the RR subgroup.
• Achieving a postoperative collateral flow index ≤20% significantly increases the likelihood of reducing ventricle size (13-fold increase, P < .03).