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1.
Nature ; 627(8002): 165-173, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38326613

RESUMO

The arachnoid barrier delineates the border between the central nervous system and dura mater. Although the arachnoid barrier creates a partition, communication between the central nervous system and the dura mater is crucial for waste clearance and immune surveillance1,2. How the arachnoid barrier balances separation and communication is poorly understood. Here, using transcriptomic data, we developed transgenic mice to examine specific anatomical structures that function as routes across the arachnoid barrier. Bridging veins create discontinuities where they cross the arachnoid barrier, forming structures that we termed arachnoid cuff exit (ACE) points. The openings that ACE points create allow the exchange of fluids and molecules between the subarachnoid space and the dura, enabling the drainage of cerebrospinal fluid and limited entry of molecules from the dura to the subarachnoid space. In healthy human volunteers, magnetic resonance imaging tracers transit along bridging veins in a similar manner to access the subarachnoid space. Notably, in neuroinflammatory conditions such as experimental autoimmune encephalomyelitis, ACE points also enable cellular trafficking, representing a route for immune cells to directly enter the subarachnoid space from the dura mater. Collectively, our results indicate that ACE points are a critical part of the anatomy of neuroimmune communication in both mice and humans that link the central nervous system with the dura and its immunological diversity and waste clearance systems.


Assuntos
Aracnoide-Máter , Encéfalo , Dura-Máter , Animais , Humanos , Camundongos , Aracnoide-Máter/anatomia & histologia , Aracnoide-Máter/irrigação sanguínea , Aracnoide-Máter/imunologia , Aracnoide-Máter/metabolismo , Transporte Biológico , Encéfalo/anatomia & histologia , Encéfalo/irrigação sanguínea , Encéfalo/imunologia , Encéfalo/metabolismo , Dura-Máter/anatomia & histologia , Dura-Máter/irrigação sanguínea , Dura-Máter/imunologia , Dura-Máter/metabolismo , Encefalomielite Autoimune Experimental/imunologia , Encefalomielite Autoimune Experimental/metabolismo , Perfilação da Expressão Gênica , Imageamento por Ressonância Magnética , Camundongos Transgênicos , Espaço Subaracnóideo/anatomia & histologia , Espaço Subaracnóideo/irrigação sanguínea , Espaço Subaracnóideo/imunologia , Espaço Subaracnóideo/metabolismo , Líquido Cefalorraquidiano/metabolismo , Veias/metabolismo
2.
Clin Anat ; 34(5): 748-756, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33449372

RESUMO

INTRODUCTION: We have previously described arachnoid sleeves around cauda equina nerve roots, but at that time we did not determine whether injections could be performed within those sleeves. The purpose of this observational study was to establish whether the entire distal orifice of a spinal needle can be accommodated within an arachnoid sleeve. MATERIALS AND METHODS: We carefully dissected the entire dural sacs off four fresh cadavers, opened them by longitudinal incision, and immersed them in saline. Under direct vision, we penetrated the cauda equina roots nerves traveling almost vertically downward at 30 locations each with a 27- and a 25-G pencil-point needle (60 punctures total). We captured the images with a stereoscopic camera. RESULTS: The nerve root offered no noticeable resistance to needle entry. Although the arachnoid sleeves could not be identified with the naked eye, they were translucent but visible under microscopy. In 21 of 30 attempts with a 27-gauge needle, and in 20 of 30 attempts with a 25-gauge needle, the distal orifice of the spinal needle was completely within the arachnoid sleeve. CONCLUSION: It seems possible to accommodate the distal orifice of a 25- or a 27-gauge pencil-point spinal needle completely within the space of the arachnoid sleeve. An injection within this sleeve could potentially lead to a neurological syndrome, as we have previously proposed.


Assuntos
Pontos de Referência Anatômicos , Raquianestesia/efeitos adversos , Raquianestesia/métodos , Aracnoide-Máter/anatomia & histologia , Síndrome da Cauda Equina/prevenção & controle , Cauda Equina/anatomia & histologia , Radiculopatia/prevenção & controle , Cadáver , Humanos
3.
Surg Radiol Anat ; 43(8): 1311-1318, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33635406

RESUMO

PURPOSE: Few studies have explored arachnoid granulations (AGs) bulging into the cranial dural sinuses using contrast-enhanced magnetic resonance imaging (MRI). This study aimed to explore such AGs in the transverse (TS), sigmoid (SigS), and straight (StS) sinuses, and confluens sinuum (ConfS) using thin-sliced, contrast MRI. METHODS: A total of 102 patients with intact dural sinuses underwent thin-sliced, contrast MRI in the axial, coronal, and sagittal planes. RESULTS: In 88.2%, more than one AG was identified in the TS and SigS, StS, and ConfS. In the TS, AGs were identified in 40.2% on the right side and 37.3% on the left and were frequently located in the middle and lateral thirds. In the SigS, AGs were identified on the right in 17.6% and on the left in 18.6% in the distal region. In the StS, AGs were identified in 35.3% of cases, most frequently located in the proximal third, followed by the distal third. In the ConfS, AGs were identified in 20.6% of cases. Furthermore, in 23.5%, a collection of multiple AGs of varying sizes was found in the TS. A statistical difference was not shown between the mean age of 90 patients with AGs and that of 12 patients without identifiable AGs. CONCLUSIONS: Bulging AGs may more frequently found in the TS. Thin-sliced, contrast MRI is useful for delineating AGs.


Assuntos
Aracnoide-Máter/anatomia & histologia , Cavidades Cranianas/anatomia & histologia , Dura-Máter/anatomia & histologia , Adolescente , Adulto , Idoso , Aracnoide-Máter/diagnóstico por imagem , Criança , Meios de Contraste , Cavidades Cranianas/diagnóstico por imagem , Dura-Máter/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
4.
J Anat ; 237(2): 275-284, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32202332

RESUMO

Traumatic brain injury (TBI) is a common injury modality affecting a diverse patient population. Axonal injury occurs when the brain experiences excessive deformation as a result of head impact. Previous studies have shown that the arachnoid trabeculae (AT) in the subarachnoid space significantly influence the magnitude and distribution of brain deformation during impact. However, the quantity and spatial distribution of cranial AT in humans is unknown. Quantification of these microstructural features will improve understanding of force transfer during TBI, and may be a valuable dataset for microneurosurgical procedures. In this study, we quantify the spatial distribution of cranial AT in seven post-mortem human subjects. Optical coherence tomography (OCT) was used to conduct in situ imaging of AT microstructure across the surface of the human brain. OCT images were segmented to quantify the relative amounts of trabecular structures through a volume fraction (VF) measurement. The average VF for each brain ranged from 22.0% to 29.2%. Across all brains, there was a positive spatial correlation, with VF significantly greater by 12% near the superior aspect of the brain (p < .005), and significantly greater by 5%-10% in the frontal lobes (p < .005). These findings suggest that the distribution of AT between the brain and skull is heterogeneous, region-dependent, and likely contributes to brain deformation patterns. This study is the first to image and quantify human AT across the cerebrum and identify region-dependencies. Incorporation of this spatial heterogeneity may improve the accuracy of computational models of human TBI and enhance understanding of brain dynamics.


Assuntos
Aracnoide-Máter/anatomia & histologia , Encéfalo/anatomia & histologia , Pia-Máter/anatomia & histologia , Crânio/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aracnoide-Máter/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pia-Máter/diagnóstico por imagem , Crânio/diagnóstico por imagem , Tomografia de Coerência Óptica
5.
Acta Neurochir (Wien) ; 162(9): 2235-2244, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32193727

RESUMO

BACKGROUND: The membrane of Liliequist is one of the best-known inner arachnoid membranes and an essential intraoperative landmark when approaching the interpeduncular cistern but also an obstacle in the growth of lesions in the sellar and parasellar regions. The limits and exact anatomical description of this membrane are still unclear, as it blends into surrounding structures and joins other arachnoid membranes. METHODS: We performed a systematic narrative review by searching for articles describing the anatomy and the relationship of the membrane of Liliequist with surrounding structures in MEDLINE, Embase and Google Scholar. Included articles were cross-checked for missing references. Both preclinical and clinical studies were included, if they detailed the clinical relevance of the membrane of Liliequist. RESULTS: Despite a common definition of the localisation of the membrane of Liliequist, important differences exist with respect to its anatomical borders. The membrane appears to be continuous with the pontomesencephalic and pontomedullary membranes, leading to an arachnoid membrane complex around the brainstem. Furthermore, Liliequist's membrane most likely continues along the oculomotor nerve sheath in the cavernous sinus, blending into and giving rise to the carotid-oculomotor membrane. CONCLUSION: Further standardized anatomical studies are needed to clarify the relation of the membrane of Liliequist with surrounding structures but also the anatomy of the arachnoid membranes in general. Our study supports this endeavour by identifying the knowledge hiatuses and reviewing the current knowledge base.


Assuntos
Aracnoide-Máter/cirurgia , Encéfalo/cirurgia , Procedimentos Neurocirúrgicos/métodos , Aracnoide-Máter/anatomia & histologia , Encéfalo/anatomia & histologia , Humanos
6.
J Anat ; 234(3): 316-326, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30565214

RESUMO

A thorough knowledge of the gross and micro-anatomy of the human internal acoustic canal (IAC) is essential in vestibular schwannoma removal, cochlear implantation (CI) surgery, vestibular nerve section, and decompression procedures. Here, we analyzed the acoustic-facial cistern of the human IAC, including nerves and anastomoses using synchrotron phase contrast imaging (SR-PCI). A total of 26 fresh human temporal bones underwent SR-PCI. Data were processed using volume-rendering software to create three-dimensional (3D) reconstructions allowing soft tissue analyses, orthogonal sectioning, and cropping. A scalar opacity mapping tool was used to enhance tissue surface borders, and anatomical structures were color-labeled for improved 3D comprehension of the soft tissues. SR-PCI reproduced, for the first time, the variable 3D anatomy of the human IAC, including cranial nerve complexes, anastomoses, and arachnoid membrane invagination (acoustic-facial cistern; an extension of the cerebellopontine cistern) in unprocessed, un-decalcified specimens. An unrecognized system of arachnoid pillars and trabeculae was found to extend between the arachnoid and cranial nerves. We confirmed earlier findings that intra-meatal vestibular schwannoma may grow unseparated from adjacent nerves without duplication of the arachnoid layers. The arachnoid pillars may support and stabilize cranial nerves in the IAC and could also play a role in local fluid hydrodynamics.


Assuntos
Aracnoide-Máter/anatomia & histologia , Orelha Interna/anatomia & histologia , Imageamento Tridimensional/métodos , Osso Temporal/anatomia & histologia , Humanos , Neuroma Acústico/etiologia , Microtomografia por Raio-X/métodos
7.
Surg Radiol Anat ; 39(5): 541-545, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27646644

RESUMO

PURPOSE: Arachnoid granulations (AGs) occasionally appear to protrude into the calvarial convexity, lying close to the bridging veins (BVs). This study aims to characterize such AGs and BVs using magnetic resonance imaging (MRI). METHODS: Ninety-five patients were enrolled in this study. Initially, stepwise frontal craniotomy was performed in an injected cadaver head. Next, examinations with contrast MRI were performed involving the whole cranial vault. RESULTS: In cadaveric dissection, the AGs located in the parasagittal regions appeared as outward protrusions through the dura mater and in contact with the diploic veins. Forming tent-shaped sleeves, these AGs and the continuous arachnoid membranes suspended the BVs coursing just below. A total of 237 AGs were identified on contrast MRI that protruded into the skull, lying close to the BVs. Among them, 78 % were located in parasagittal regions as AG-BV pairs. These pairs were most frequently found in the middle third of the calvarial hemisphere, followed by the anterior and posterior thirds. In 34 %, the BV segments were lodged in the AGs. CONCLUSIONS: Some AGs located in the parasagittal regions and cerebral convexity pass through the dura mater and pile drive into the skull, which contribute to forming hanging-type arachnoid sleeves suspending the BVs. These structures may underpin the predisposition of BVs to injury following mechanical impacts.


Assuntos
Aracnoide-Máter/anatomia & histologia , Aracnoide-Máter/diagnóstico por imagem , Veias Cerebrais/anatomia & histologia , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Cadáver , Meios de Contraste , Dura-Máter/anatomia & histologia , Dura-Máter/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Crânio/anatomia & histologia , Crânio/diagnóstico por imagem
8.
Childs Nerv Syst ; 31(1): 15-28, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25395307

RESUMO

INTRODUCTION: Liliequist's membrane is an arachnoid membrane that forms a barrier within the basilar cisternal complex. This structure is an important landmark in approaches to the sellar and parasellar regions. The importance of this membrane was largely recognized after the advance of neuroendoscopic techniques. Many studies were, thereafter, published reporting different anatomic findings. METHOD: A detailed search for studies reporting anatomic and surgical findings of Liliequist's membrane was performed using "PubMed," and included all the available literature. Manual search for manuscripts was also conducted on references of papers reporting reviews. RESULTS: Liliequist's membrane has received more attention recently. The studies have reported widely variable results, which were systematically organized in this paper to address the controversy. CONCLUSION: Regardless of its clinical and surgical significance, the anatomy of Liliequist's membrane is still a matter of debate.


Assuntos
Aracnoide-Máter/anatomia & histologia , Neurocirurgia , Humanos , PubMed/estatística & dados numéricos , Espaço Subaracnóideo/anatomia & histologia
9.
Surg Radiol Anat ; 37(2): 127-38, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25135312

RESUMO

Most neurosurgical procedures could be performed noninvasively by working through the natural corridors provided by the subarachnoid cisterns. In consequence, the subarachnoid cisterns have been considered as the roadmaps for the microneurosurgeons. The concept and the contents of the cisterns have been well known and described, but the knowledge of the detailed anatomy of the arachnoid membranes, which are the real septa of the cisterns and provide the practical and important landmarks and planes for the dissections during the brain surgeries, is still lacking. The present article reviews the previous reports of the intracranial arachnoid membranes with a special emphasis on the microsurgical anatomy and the clinical significance.


Assuntos
Aracnoide-Máter/anatomia & histologia , Aracnoide-Máter/cirurgia , Encéfalo/anatomia & histologia , Encéfalo/cirurgia , Cadáver , Humanos
10.
Br J Neurosurg ; 28(1): 98-106, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23869573

RESUMO

PURPOSE: The Sylvian (or lateral) fissure is an important structure that has both pathophysiological and microneurosurgical significance. The aims of this review were to revisit the anatomy of the Sylvian fissure and cistern and its overlying arachnoid membrane, and to review its role in the treatment of various surgical pathological lesions. METHODS: For the most part, a PubMed search was used in obtaining English abstracts and full-text references for this article. The criterion for inclusion of an article in the references for this review was that it included materials about the anatomical or the clinical properties of the Sylvian fissure, cistern and arachnoid membrane. The relevant books were also used in obtaining supplementary citations. RESULTS: The review presented the anatomy and disease states associated with the Sylvian fissure. CONCLUSIONS: A good knowledge of the anatomy of the Sylvian fissure, cistern and its associated arachnoid mater is crucial in the proper diagnosis and neurosurgical management of various pathological conditions.


Assuntos
Cistos Aracnóideos/patologia , Aracnoide-Máter/anatomia & histologia , Cérebro/anatomia & histologia , Humanos
11.
Childs Nerv Syst ; 29(1): 17-33, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22961357

RESUMO

INTRODUCTION: The arachnoid mater is a delicate and avascular layer that lies in direct contact with the dura and is separated from the pia mater by the cerebrospinal fluid-filled subarachnoid space. The subarachnoid space is divided into cisterns named according to surrounding brain structures. METHODS: The medical literature on this meningeal layer was reviewed in regard to historical aspects, etymology, embryology, histology, and anatomy with special emphasis on the arachnoid cisterns. Cerebrospinal fluid dynamics are discussed along with a section devoted to arachnoid cysts. CONCLUSION: Knowledge on the arachnoid mater and cerebrospinal fluid dynamics has evolved over time and is of great significance to the neurosurgeon in clinical practice.


Assuntos
Cistos Aracnóideos , Aracnoide-Máter/anatomia & histologia , Dura-Máter/anatomia & histologia , Aracnoide-Máter/embriologia , Cistos Aracnóideos/história , Cistos Aracnóideos/patologia , Cistos Aracnóideos/cirurgia , Líquido Cefalorraquidiano/fisiologia , Bases de Dados Factuais , Dura-Máter/embriologia , História do Século XX , Humanos
12.
Neuron ; 111(23): 3745-3764.e7, 2023 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-37776854

RESUMO

Leptomeninges, consisting of the pia mater and arachnoid, form a connective tissue investment and barrier enclosure of the brain. The exact nature of leptomeningeal cells has long been debated. In this study, we identify five molecularly distinct fibroblast-like transcriptomes in cerebral leptomeninges; link them to anatomically distinct cell types of the pia, inner arachnoid, outer arachnoid barrier, and dural border layer; and contrast them to a sixth fibroblast-like transcriptome present in the choroid plexus and median eminence. Newly identified transcriptional markers enabled molecular characterization of cell types responsible for adherence of arachnoid layers to one another and for the arachnoid barrier. These markers also proved useful in identifying the molecular features of leptomeningeal development, injury, and repair that were preserved or changed after traumatic brain injury. Together, the findings highlight the value of identifying fibroblast transcriptional subsets and their cellular locations toward advancing the understanding of leptomeningeal physiology and pathology.


Assuntos
Aracnoide-Máter , Meninges , Camundongos , Animais , Aracnoide-Máter/anatomia & histologia , Pia-Máter , Plexo Corióideo , Encéfalo
13.
Childs Nerv Syst ; 28(1): 65-72, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21964508

RESUMO

PURPOSE: In previous studies, some disagreements regarding the nature (inner or outer arachnoid membrane) and lateral boundaries (temporal uncus or tentorial edge) of Liliequist's membrane remain. The aim was to clarify whether Liliequist's membrane is an inner or outer arachnoid membrane, and the distribution of Liliequist's membrane with emphasis on its lateral attachments. METHODS: Liliequist's membrane was investigated by microsurgical dissection in 24 formalin-fixed adult cadaver heads and by histological sections of sellar-suprasellar specimens from another four formalin-fixed adult cadaver heads. RESULTS: The results obtained in the present study indicated that 1) Liliequist's membrane arises from the basal arachnoid membrane and has two components: a basal part comprising a folding inner layer of the arachnoid mater and an attaching part consisting of accumulated arachnoid trabeculae; 2) similar histological features are also present in other inner arachnoid membranes with attachments on basal arachnoid membrane, demonstrating Liliequist's membrane is an inner arachnoid membrane; 3) laterally, Liliequist's membrane attaches to the anterior tentorial edge constantly and to the mesial temporal uncus in more than half; 4) the oculomotor nerve courses above Liliequist's membrane and is fixed on Liliequist's membrane by the oculomotor membrane, which can also attach on temporal uncus and should be differentiated from the true temporal attachments of Liliequist's membrane. CONCLUSION: Liliequist's membrane is an inner rather than outer arachnoid membrane. Understanding of its individual variation and topographic relationships with surrounding neurovascular and arachnoid structures is important for neurosurgical practice.


Assuntos
Aracnoide-Máter/anatomia & histologia , Encéfalo/anatomia & histologia , Adulto , Cadáver , Humanos
14.
Acta Neurochir (Wien) ; 154(4): 667-74; discussion 674, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22075732

RESUMO

BACKGROUND: In the past, sporadic demonstrations of the existence of a subarachnoid subdiaphragmatic cistern have been published. The aim of this study was to evaluate the anatomical characteristics of the subdiaphragmatic cistern of the pituitary gland. METHODS: After a complete review of the literature published on the topic, we report anatomical observations of the subdiaphragmatic cistern and its relationship to the pituitary gland and to the chiasmatic cistern. Ten cadaveric heads were studied using different techniques and surgical methods (plastination, plastic casts of the subarachnoid spaces, microscopic and transsphenoidal endoscopic approaches). Moreover, 3-T magnetic resonance images of ten healthy volunteers were analyzed to investigate the presence and anatomical variability of the subdiaphragmatic cistern. RESULTS: By means of our qualitative radioanatomic study, we found that the roof of the subdiaphragmatic cistern is formed by the diaphragma sellae, the floor by the superior face of the pituitary gland, the lateral walls by the arachnoidea extending laterally through the medial walls of the cavernous sinus, and the medial walls by the infundibular stem. The subdiaphragmatic cistern communicates by means of the ostium of the diaphragm with the chiasmatic cistern. CONCLUSION: We confirmed the existence of the subdiaphragmatic cistern. The overused term "suprasellar cistern" refers more to a complex of cisterns, formed by the subdiaphragmatic cistern, below the diaphragma sella, and by the chiasmatic cistern, above it, in direct communication with the lamina terminalis and carotid cisterns.


Assuntos
Aracnoide-Máter/anatomia & histologia , Aracnoide-Máter/cirurgia , Dura-Máter/anatomia & histologia , Dura-Máter/cirurgia , Hipófise/anatomia & histologia , Hipófise/cirurgia , Espaço Subaracnóideo/anatomia & histologia , Espaço Subaracnóideo/cirurgia , Aracnoide-Máter/diagnóstico por imagem , Cadáver , Dura-Máter/diagnóstico por imagem , Humanos , Hipófise/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Espaço Subaracnóideo/diagnóstico por imagem
15.
AJNR Am J Neuroradiol ; 43(2): 167-175, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34711549

RESUMO

The arachnoid membranes are projections of connective tissue in the subarachnoid space that connect the arachnoid mater to the pia mater. These are underappreciated and largely unrecognized by most neuroradiologists despite being found to be increasingly important in the pathogenesis, imaging, and treatment of communicating hydrocephalus. This review aims to provide neuroradiologists with an overview of the history, embryology, histology, anatomy, and normal imaging appearance of these membranes, as well as some examples of their clinical importance.


Assuntos
Estado de Consciência , Radiologia , Aracnoide-Máter/anatomia & histologia , Aracnoide-Máter/diagnóstico por imagem , Humanos , Pia-Máter , Espaço Subaracnóideo/diagnóstico por imagem
16.
Acta Neurochir (Wien) ; 153(1): 191-200, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20936312

RESUMO

OBJECT: Liliequist's membrane (LM) is an important arachnoid structure in the basal cisterns. The relevant anatomic descriptions of this membrane and how many leaves it has are still controversial. The existing anatomical theories do not satisfy the needs of minimally invasive neurosurgery. We aimed to establish the three-dimensional configuration of LM. METHODS: Fifteen adult formalin-fixed cadaver heads were dissected under a surgical microscope to carefully observe the arachnoid mater in the suprasellar and post-sellar areas and to investigate the arachnoid structure and its surrounding attachments. RESULTS: It was found that the LM actually consists of three types of membranes. The diencephalic membrane (DM) was usually attached by the mesencephalic membrane (MM) from underneath, and above DM it was usually a pair of hypothalamic membranes (HMs) extending superomedially. The pair of HMs was stretched between the DM (or MM) and the hypothalamus and were seldom attached to the carotid-chiasmatic walls between the carotid cistern and the chiasmatic cistern. These three types of membranes (DM, MM, and HM) comprised the main arachnoid structure in the anterior incisural space and often presented as four connected leaves. However, only two thirds of the specimens had all three types of membranes, and there was considerable variation in the characteristics and shapes of the membranes among the specimens. CONCLUSION: All three types of membranes comprising LM serve as important anatomical landmarks and interfaces for surgical procedures in this area.


Assuntos
Aracnoide-Máter/anatomia & histologia , Encéfalo/anatomia & histologia , Fossa Craniana Média/anatomia & histologia , Base do Crânio/anatomia & histologia , Espaço Subaracnóideo/anatomia & histologia , Aracnoide-Máter/fisiologia , Encéfalo/fisiologia , Cadáver , Fossa Craniana Média/fisiologia , Humanos , Base do Crânio/fisiologia , Espaço Subaracnóideo/fisiologia
17.
Acta Neurochir (Wien) ; 153(8): 1701-11, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21380853

RESUMO

BACKGROUND: Liliequist's membrane is mostly described as having a diencephalic leaf, mesencephalic leaf, and diencephalic-mesencephalic leaves in the literature. Also different descriptions of the prepontine membranes were reported. In this study, we visualized the regular structural forms of membranes without disturbing any attachments and defined infrachiasmatic and prepontine safety zones. We discussed the clinical significance of these structures. MATERIALS AND METHODS: The study was carried out on 24 adult human cadavers at the Morgue Specialization Department of the Forensic Medicine Institution following the initial autopsy examination. Liliequist's membrane and the prepontine membranes were explored after retraction of the frontal lobes. Dissections were performed under the operative microscope. A 0- and 30-degree, 2.7-mm angled rigid endoscope (Aesculap, Tuttlingen, Germany) was advanced through the prepontine cistern from the natural holes of membranes, or small holes were opened without damaging the surrounding structures. RESULTS: The basal arachnoid membrane (BAM) continued as Liliequist's membrane (LM) without any distinct separation in all specimens. The LM coursed over the posterior clinoids and split into two leaves as the diencephalic leaf (DL) and mesencephalic leaf (ML) in 18 specimens; the medial pontomesencephalic membrane (MPMM) coursed anterolaterally as a continuation of the ML and attached to the medial surfaces of the fifth and sixth nerves, joining with the lateral pontomesencephalic membrane (LPMM), which was also a posterolateral continuation of the ML in all specimens. The medial pontomedullar membrane (MPMdM) and lateral pontomedullar membrane (LPMdM) were observed in 21 specimens. The MPMdM membrane was a continuation of the MPMM, and the LPMdM was a continuation of the LPMM in all 21 specimens. CONCLUSION: We observed that the LM is a borderless continuation of the BAM. The MPMM and LPMM split from the ML without any interruptions. The MPMdM and LPMdM were a single membrane continuing from the MPMM and LPMM. We determined infrachiasmatic and prepontine areas that can be important for inferior surgical approaches.


Assuntos
Aracnoide-Máter/anatomia & histologia , Aracnoide-Máter/cirurgia , Ponte/anatomia & histologia , Ponte/cirurgia , Espaço Subaracnóideo/anatomia & histologia , Espaço Subaracnóideo/cirurgia , Adulto , Cadáver , Dissecação/instrumentação , Dissecação/métodos , Humanos , Microcirurgia/instrumentação , Microcirurgia/métodos , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos
18.
J Craniofac Surg ; 22(1): 118-21, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21187766

RESUMO

INTRODUCTION: When performing in situ harvesting of cranial bone grafts, there is a risk of entering the pericranial-intracranial venous system, either directly or indirectly through the arachnoid foveolae. The aims of this study were to investigate the size and location of arachnoid foveolae and to provide an anatomic road map to prevent penetrating these structures. METHODS: Three hundred dry skulls were selected from the Hamann-Todd osteological collection (Cleveland, OH); skulls were collected between 1912 and 1938. Our study skulls were limited to whites or African American adults. Exclusion criteria included children (<18 y), ethnic groups other than African Americans and whites, skulls demonstrating fracture or craniofacial abnormalities, or any skull whose age, ethnicity, and sex could not be confirmed. From the 300 skulls in the collection, 200 met the criteria and were included in our review. The mean age of these 200 individuals was 43.86 years, with a male-to-female proportion of 100:100, and a white-to-African American proportion of 144:56. A 500-W candescent light was used to transilluminate the arachnoid foveola, and digital photographs with scale were obtained. The location and diameters of foveolae for arachnoid granulations relative to the coronal and sagittal suture were measured. CONCLUSIONS: Approximately 90% of major arachnoid foveolae are located within 2.5 cm of the coronal and 1.5 cm of the sagittal suture for the left and right parietal bones. Major arachnoid foveolae are located at closer distances to the superior sagittal suture and the coronal suture in the right and left parietal bone than minor foveolae. The results of this study imply that potential complications can be minimized by avoiding these areas and by harvesting in situ bone grafts from the absolute and relative safe zones described in this study.


Assuntos
Aracnoide-Máter/anatomia & histologia , Suturas Cranianas/anatomia & histologia , Crânio/anatomia & histologia , Adulto , Transplante Ósseo , Cadáver , Feminino , Humanos , Masculino , Fotografação , Crânio/transplante
19.
World Neurosurg ; 151: e372-e378, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33887497

RESUMO

BACKGROUND: The occipital transtentorial approach (OTA) is a very useful but challenging approach to expose the pineal region because the deep-seated arachnoid membranes usually fold and extend over the great vein of Galen (GVG), leading to dense and poor visibility. In addition, the practical aspects of arachnoid anatomy are not well understood. We aimed to develop a safe surgical procedure for the OTA according to the practical aspects of arachnoid anatomy. METHODS: The procedure is shown through an illustrative video of surgery and cadaver. Five cadavers were analyzed for their arachnoid structures and the surgical procedures via the OTA, in strict compliance with legal and ethical requirements. RESULTS: All cadavers showed a 2-layered arachnoid structure-one belonging to the occipital lobe, and the other to the cerebellum. According to our cadaveric analysis, the arachnoid attachment of the tentorial apex can be peeled bluntly, with an average distance of 10.2 mm. For our clinical presentation, a pineal tumor with hydrocephalus was detected in a 14-year-old boy. While using the OTA and expanding the deep surgical field, we detached the membrane from the tentorial apex and bluntly peeled it to reveal the deep veins. Finally, gross total removal of the tumor was achieved. CONCLUSIONS: A 2-layered arachnoid structure interposes the GVG from above and below the tentorium. The arachnoid membrane below the tentorium can be peeled off bluntly from the GVG to the attachment bundle limited by the penetrating veins. This detachment technique is useful for safe enlargement of the surgical field for the OTA.


Assuntos
Aracnoide-Máter/anatomia & histologia , Encéfalo/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aracnoide-Máter/cirurgia , Cadáver , Feminino , Humanos , Masculino
20.
Fluids Barriers CNS ; 17(1): 68, 2020 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-33183314

RESUMO

BACKGROUND: The pia arachnoid complex (PAC) is a cerebrospinal fluid-filled tissue conglomerate that surrounds the brain and spinal cord. Pia mater adheres directly to the surface of the brain while the arachnoid mater adheres to the deep surface of the dura mater. Collagen fibers, known as subarachnoid trabeculae (SAT) fibers, and microvascular structure lie intermediately to the pia and arachnoid meninges. Due to its structural role, alterations to the biomechanical properties of the PAC may change surface stress loading in traumatic brain injury (TBI) caused by sub-concussive hits. The aim of this study was to quantify the mechanical and morphological properties of ovine PAC. METHODS: Ovine brain samples (n = 10) were removed from the skull and tissue was harvested within 30 min post-mortem. To access the PAC, ovine skulls were split medially from the occipital region down the nasal bone on the superior and inferior aspects of the skull. A template was used to remove arachnoid samples from the left and right sides of the frontal and occipital regions of the brain. 10 ex-vivo samples were tested with uniaxial tension at 2 mm s-1, average strain rate of 0.59 s-1, until failure at < 5 h post extraction. The force and displacement data were acquired at 100 Hz. PAC tissue collagen fiber microstructure was characterized using second-harmonic generation (SHG) imaging on a subset of n = 4 stained tissue samples. To differentiate transverse blood vessels from SAT by visualization of cell nuclei and endothelial cells, samples were stained with DAPI and anti-von Willebrand Factor, respectively. The Mooney-Rivlin model for average stress-strain curve fit was used to model PAC material properties. RESULTS: The elastic modulus, ultimate stress, and ultimate strain were found to be 7.7 ± 3.0, 2.7 ± 0.76 MPa, and 0.60 ± 0.13, respectively. No statistical significance was found across brain dissection locations in terms of biomechanical properties. SHG images were post-processed to obtain average SAT fiber intersection density, concentration, porosity, tortuosity, segment length, orientation, radial counts, and diameter as 0.23, 26.14, 73.86%, 1.07 ± 0.28, 17.33 ± 15.25 µm, 84.66 ± 49.18°, 8.15%, 3.46 ± 1.62 µm, respectively. CONCLUSION: For the sizes, strain, and strain rates tested, our results suggest that ovine PAC mechanical behavior is isotropic, and that the Mooney-Rivlin model is an appropriate curve-fitting constitutive equation for obtaining material parameters of PAC tissues.


Assuntos
Aracnoide-Máter/anatomia & histologia , Aracnoide-Máter/fisiologia , Fenômenos Biomecânicos/fisiologia , Pia-Máter/anatomia & histologia , Pia-Máter/fisiologia , Animais , Modelos Animais , Modelos Biológicos , Ovinos
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