Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized 
by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening 
of collaterals and insufficient drainage proved by reduced cerebral blood flow 
and increased mean transit time in cerebral MRI perfusional study. The present 
review is aimed to give a comprehensive overview of the actual status of the art 
of the diagnosis and treatment of this condition. As far as the origin of venous 
narrowing is concerned, phlebographic studies of the IJVs and AZ systems 
demonstrated that venous stenoses were likely to be truncular venous 
malformations; mostly, they are intraluminal defects such as malformed valve, 
septa webs. CCSVI condition has been found to be strongly associated with 
multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease 
considered autoimmune in nature. In several epidemiological observations 
performed at different latitudes on patients with different genetic backgrounds, 
the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using 
venous MR and/or different Doppler protocols, CCSVI was not detected with the 
same prevalence. Two pilot studies demonstrated the safety and feasibility in 
Day Surgery of the endovascular treatment of CCSVI by means of balloon 
angioplasty (PTA). It determines a significant reduction of postoperative venous 
pressure. Restenosis rate was found out elevated in the IJVs, but negligible in 
the AZ. However, PTA seems to positively influence clinical and QoL parameters 
of the associated MS and warrants further randomized control trials.