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1.
Neurol India ; 72(1): 117-123, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38443012

RESUMO

IgG4-related disease (IgG4-RD) is an immune-mediated multi-system disorder. The nervous system (IgG4-RND) is rarely affected. We describe a short case series. We performed an ambispective analysis of IgG4-RND patients admitted at our centre between January 2016 and December 2022. Eight patients (M: F-2:6) were included with a mean age at presentation of 40.63 ± 17.88 years and disease duration of 5.16 ± 4.08 years. The common diseased sites were pachymeninges (7), orbits (4), paranasal sinuses (3), frontal lobe (1), hypophysis (1), leptomeninges (1), and middle ear (1). Common symptoms were headache and cranial neuropathy. The common nerves involved were the optic nerve, followed by the third, fifth, sixth, and seventh. Cerebrospinal fluid showed lymphocytic pleocytosis. Histopathology showed lymphoplasmacytic infiltrate (8), fibrosis (5), >10 IgG4 + cells (7), and IgG4/IgG >40% (6). Six had a relapsing course. The rituximab-based treatment regimen showed a favourable response.


Assuntos
Doença Relacionada a Imunoglobulina G4 , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Dura-Máter , Lobo Frontal , Imunoglobulina G , Índia
2.
Sci Transl Med ; 16(739): eadj0616, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38507468

RESUMO

Complete sequestration of central nervous system tissue and cerebrospinal fluid by the dural membrane is fundamental to maintaining homeostasis and proper organ function, making reconstruction of this layer an essential step during neurosurgery. Primary closure of the dura by suture repair is the current standard, despite facing technical, microenvironmental, and anatomic challenges. Here, we apply a mechanically tough hydrogel paired with a bioadhesive for intraoperative sealing of the dural membrane in rodent, porcine, and human central nervous system tissue. Tensile testing demonstrated that this dural tough adhesive (DTA) exhibited greater toughness with higher maximum stress and stretch compared with commercial sealants in aqueous environments. To evaluate the performance of DTA in the range of intracranial pressure typical of healthy and disease states, ex vivo burst pressure testing was conducted until failure after DTA or commercial sealant application on ex vivo porcine dura with a punch biopsy injury. In contrast to commercial sealants, DTA remained adhered to the porcine dura through increasing pressure up to 300 millimeters of mercury and achieved a greater maximum burst pressure. Feasibility of DTA to repair cerebrospinal fluid leak in a simulated surgical context was evaluated in postmortem human dural tissue. DTA supported effective sutureless repair of the porcine thecal sac in vivo. Biocompatibility and adhesion of DTA was maintained for up to 4 weeks in rodents after implantation. The findings suggest the potential of DTA to augment or perhaps even supplant suture repair and warrant further exploration.


Assuntos
Hidrogéis , Adesivos Teciduais , Humanos , Animais , Suínos , Hidrogéis/farmacologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Procedimentos Neurocirúrgicos , Dura-Máter/cirurgia , Sistema Nervoso Central , Adesivos Teciduais/farmacologia
3.
Am J Case Rep ; 25: e941441, 2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38439524

RESUMO

BACKGROUND Acute ischemic stroke in the posterior cerebral artery (PCA) territory can lead to persistent disabling deficits. The PCA is divided into 4 segments. The P2 segment begins at the posterior communicating artery and curves around the midbrain and above the tentorium cerebelli. This report is of a 61-year-old man with acute ischemic stroke involving the left hippocampus treated with direct thrombectomy of the P2 segment of the PCA. CASE REPORT A 61-year-old white man presented with transient amnesia, aphasia, right-sided hemianopia, dizziness, and persistent acute memory deficits. Magnetic resonance imaging (MRI) showed a left hippocampal acute ischemic stroke with left PCA occlusion in the P2 segment. Despite a low National Institutes of Health Stroke Scale (NIHSS) score and the already-formed lesion in the hippocampus, successful stent retriever thrombectomy was performed due to a considerable perfusion-diffusion mismatch and a persistent potentially disabling neurocognitive deficit. Due to partial thrombus dislocation, occlusion of the common origin of the right posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) occurred and was immediately treated by thrombectomy to prevent severe cerebellar infarction. His clinical symptoms completely resolved and a neuropsychological exam showed no residual deficits. CONCLUSIONS Thrombectomy of the P2 segment of the PCA is feasible and can be considered to treat patients with acute occlusion at risk for persistent disabling deficits, based on clinical estimation of the impact of such deficits and the presence of potentially salvageable brain tissue. Potential procedural complications should be sought out and immediately treated, if technically feasible.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Estados Unidos , Masculino , Humanos , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Artéria Cerebral Posterior/cirurgia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Dura-Máter
4.
Cell Mol Neurobiol ; 44(1): 18, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38315435

RESUMO

Multiple studies have shown that clinical events resulting into neonatal IL-4 over-exposure, such as asthma in early life and food allergy, were associated with brain damage and that the neuroinflammation induced by them might lead to cognitive impairments, anxiety-/depressive-like behaviors. IL-4 is the most major elevated cytokine in periphery when these clinical events occur and peripheral IL-4 level positively correlates with the severity of those events. Our previous studies have verified that neonatal IL-4 over-exposure induced a delayed neuroinflammatory damage in rodents, which might have adverse implications for brain development and cognition. Neuroinflammation in brain parenchyma is often accompanied by changes in CSF cytokines levels. However, whether the cytokines levels in CSF change after neonatal IL-4 over-exposure is unknown. Here, we found a delayed pro-inflammatory cytokines response (higher IL-6, IL-1ß and, TNF levels) in both hippocampus and CSF after an instant anti-inflammatory cytokine response in IL-4 over-exposed rats. Moreover, the pro-inflammatory cytokines response appeared earlier in CSF than in hippocampus. The level of each of the pro-inflammatory cytokines in CSF positively correlated with that in hippocampus at the age of postnatal day 42. More microglia numbers/activation and higher M-CSF level in the hippocampus in IL-4 over-exposed rats were also observed. Furthermore, there were more macrophages with inflammatory activation in dural mater of IL-4 over-exposed rats. In sum, neonatal IL-4 over-exposure in rats induces delayed inflammation in CSF, suggesting CSF examination may serve as a potential method in predicting delayed neuroinflammation in brain following neonatal IL-4 over-exposure.


Assuntos
Citocinas , Interleucina-4 , Macrófagos , Animais , Ratos , Anti-Inflamatórios , Citocinas/líquido cefalorraquidiano , Dura-Máter , Doenças Neuroinflamatórias , Animais Recém-Nascidos
5.
Medicina (Kaunas) ; 60(2)2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38399497

RESUMO

Background and Objectives: The adult superficial middle cerebral vein (SMCV) commonly drains into the middle cranial fossa. However, different embryonic types persist, in which the SMCV drains into the lateral sinus. The basal type of SMCV coursing on the middle fossa floor is a scarce variant. Materials and Methods: During a retrospective study of archived computed tomography angiography (CTA) and magnetic resonance angiography (MRA) files, three rare adult cases of the basal or sphenopetrosal type of SMCV were found and further documented. Results: In the first case, which was evaluated via CTA, the basal type of SMCV formed a sagittal loop. It continued on the middle fossa floor, over a dehiscent tegmen tympani, to drain into the lateral sinus. In the second case, documented via MRA, the basal type of SMCV's anterior loop was in the coronal plane and closely related to the internal carotid artery and the cavernous sinus. It continued with the basal segment over a dehiscent glenoid fossa of the temporomandibular joint (TMJ). In the third case, documented via CTA, the initial cerebral part of the SMCV had a large fenestration. The middle fossa floor coursed within a well-configured sulcus of the SMCV and received a tributary through the tympanic roof. Its terminal had a tentorial course. Conclusions: Beyond the fact that such rare variants of the SMCV can unexpectedly interfere with specific approaches via the middle fossa, dehiscences of the middle fossa floor beneath such variants can determine otic or TMJ symptoms. Possible loops and fenestrations of the SMCV should be considered and documented preoperatively.


Assuntos
Veias Cerebrais , Adulto , Humanos , Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Angiografia por Tomografia Computadorizada , Dura-Máter
6.
Chem Commun (Camb) ; 60(17): 2353-2356, 2024 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-38323482

RESUMO

Artificial spinal dura mater was designed by combining solution blow-spun gelatin microfibers and dopamine-capped polyurethane bioadhesive. Notably, the gelatin microfibers had a special pore structure, good water adsorption capability, and excellent burst pressure resistance. The bioadhesive layer contributed to the excellent sealing performance in the wet state. This material provides a promising alternative as an artificial spinal dura mater to prevent cerebrospinal fluid leakage.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Gelatina , Humanos , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Dura-Máter , Água
7.
Clin Nucl Med ; 49(4): 361-363, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38350075

RESUMO

ABSTRACT: A 72-year-old man with fever and weakness in both lower limbs underwent thoracolumbar MRI and 18 F-FDG PET/CT. The PET/CT scan revealed diffused FDG uptake along the spinal dura mater from T7 to S2 level like a "bottle brush." Pathologic examination after biopsy of spinal canal lesions manifested granulomatous inflammation. The blood test showed cytoplasmic antineutrophil cytoplasmic antibody (ANCA) and myeloperoxidase-ANCAs were positive, whereas the perinuclear ANCA was negative. Eventually, he was diagnosed with granulomatosis with polyangiitis.


Assuntos
Granulomatose com Poliangiite , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Masculino , Humanos , Idoso , Fluordesoxiglucose F18 , Anticorpos Anticitoplasma de Neutrófilos , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico por imagem , Dura-Máter/diagnóstico por imagem
8.
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
9.
J Hematop ; 17(1): 41-44, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38376722

RESUMO

A 22-year-old man presented at the emergency department with progressive headache, vomiting and horizontal diplopia over 2-month period. He also developed blurred vision in his left eye. He complained of loss of appetite for the past 2 months, resulting in a 5-kg weight loss. Examination upon arrival revealed papilledema and bilateral abducens nerve palsy. Motor and sensory functions were intact. Magnetic resonance imaging (MRI) of the brain revealed multiple extra-axial nodular enhancing lesions with size of 5-10 mm mainly along with both sides of falx cerebri and vasogenic brain oedema (Fig. 1). Stereotactic brain biopsy was performed to obtain tissue diagnosis. Histologic examination revealed brain infiltration by few atypical cells hidden amongst abundant and mixed population of inflammatory cells including lymphocytes and histiocytes. The atypical cells are large cells with horseshoe nuclei (red arrow; Fig. 2A ×100 and Fig. 2B ×400). Immunohistochemistry showed strong, uniform CD30 expression (Fig. 2C ×400) and cytoplasmic ALK staining (Fig. 2D ×400), as well as for CD3 (Fig. 2E ×400) and CD68 (Fig. 2F ×400). B-cell markers (CD20) were negative (Fig. 2G ×400).


Assuntos
Edema Encefálico , Linfoma Anaplásico de Células Grandes , Humanos , Masculino , Adulto Jovem , Encéfalo , Sistema Nervoso Central , Dura-Máter , Linfoma Anaplásico de Células Grandes/diagnóstico
10.
Acta Neurochir (Wien) ; 166(1): 70, 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38326658

RESUMO

PURPOSE: In posterior fossa decompression for pediatric Chiari malformation type 1 (CM-1), duraplasty methods using various dural substitutes have been reported to improve surgical outcomes and minimize postoperative complications. To obtain sufficient posterior fossa decompression without cerebrospinal fluid-related complications, we developed a novel duraplasty technique using a combination of a pedicled dural flap and collagen matrix. The objective of this study was to describe the operative nuances of duraplasty using a combination of a pedicled dural flap and collagen matrix in posterior fossa decompression for pediatric CM-1. METHODS: We reviewed the clinical and radiographic records of 11 consecutive pediatric patients who underwent posterior fossa decompression with duraplasty using a combination of a pedicled dural flap and collagen matrix followed by expansile cranioplasty for CM-1. The largest area of the syrinx and the size of the posterior fossa were calculated. RESULTS: The maximum syrinx area was reduced by a mean of 68.5% ± 27.3% from preoperatively to postoperatively. Four patients (36.4%) had near-complete syrinx resolution (> 90%, grade III reduction), five (45.5%) had 50% to 90% reduction (grade II), and two (18.2%) had < 50% reduction (grade I). The posterior fossa area in the midsagittal section increased by 8.9% from preoperatively to postoperatively. There were no postoperative complications, including cerebrospinal fluid leakage, pseudomeningocele formation, or infection. CONCLUSION: Duraplasty using a combination of a pedicled dural flap and collagen matrix in posterior fossa decompression is a promising safe and effective surgical technique for pediatric CM-1 with syrinx.


Assuntos
Malformação de Arnold-Chiari , Siringomielia , Criança , Humanos , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia , Malformação de Arnold-Chiari/complicações , Colágeno/uso terapêutico , Descompressão Cirúrgica/métodos , Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Estudos Retrospectivos , Siringomielia/diagnóstico por imagem , Siringomielia/cirurgia , Siringomielia/complicações , Resultado do Tratamento
11.
Clin Biomech (Bristol, Avon) ; 112: 106189, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38295572

RESUMO

BACKGROUND: Cerebrospinal fluid leakage through the spinal meninges is difficult to diagnose and treat. Moreover, its underlying mechanism remains unknown. Considering that the dura mater is structurally the strongest and outermost membrane among the three-layered meninges, we hypothesized that a dural mechanical tear would trigger spontaneous cerebrospinal fluid leakage, especially when a traumatic loading event is involved. Thus, accurate biomechanical properties of the dura mater are indispensable for improving computational models, which aid in predicting blunt impact injuries and creating artificial substitutes for transplantation and surgical training. METHOD: We characterized the surface profile of the spinal dura and its mechanical properties (Young's moduli) with a distinction of its inherent anatomical sites (i.e., the cervical and lumbar regions as well as the dorsal and ventral sides of the spinal cord). FINDINGS: Although the obtained Young's moduli exhibited no considerable difference between the aforementioned anatomical sites, our results suggested that the wrinkles structurally formed along the longitudinal direction would relieve stress concentration on the dural surface under in vivo and supraphysiological conditions, enabling mechanical protection of the dural tissue from a blunt impact force that was externally applied to the spine. INTERPRETATION: This study provides fundamental data that can be used for accurately predicting cerebrospinal fluid leakage due to blunt impact trauma.


Assuntos
Dura-Máter , Coluna Vertebral , Animais , Suínos , Dura-Máter/lesões , Dura-Máter/fisiologia , Dura-Máter/cirurgia , Coluna Vertebral/cirurgia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle
12.
Surg Radiol Anat ; 46(2): 125-135, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38194160

RESUMO

Cerebrospinal fluid (CSF) circulation is considered the third circulation of the human body. Recently, some scholars have proposed the myodural bridge (MDB) as a novel power source for CSF flow. Moreover, the suboccipital muscles can exert a driving force on the CSF via the MDB. This hypothesis is directly supported by head rotation and nodding movements, which can affect CSF circulation. The MDB has been validated as a normal structure in humans and mammals. In addition, the fusion of MDB fibers of different origins that act in concert with each other forms the MDB complex (MDBC). The MDBC may be associated with several CSF disorder-related neurological disorders in clinical practice. Therefore, the morphology of the MDBC and its influencing factors must be determined. In this study, T2-weighted imaging sagittal images of the cervical region were analyzed retrospectively in 1085 patients, and magnetic resonance imaging (MRI) typing of the MDBC was performed according to the imaging features of the MDBC in the posterior atlanto-occipital interspace (PAOiS) and posterior atlanto-axial interspace (PAAiS). The effects of age and age-related degenerative changes in the cervical spine on MRI staging of the MDBC were also determined. The results revealed four MRI types of the MDBC: type A (no MDBC hyposignal shadow connected to the dura mater in either the PAOiS or PAAiS), type B (MDBC hyposignal shadow connected to the dura mater in the PAOiS only), type C (MDBC hyposignal shadow connected to the dura mater in the PAAiS only), and type D (MDBC hyposignal shadow connected to the dura mater in both the PAOiS and PAAiS). The influencing factors for the MDBC typing were age (group), degree of intervertebral space stenosis, dorsal osteophytosis, and degenerative changes in the cervical spine (P < 0.05). With increasing age (10-year interval), the incidence of type B MDBC markedly decreased, whereas that of type A MDBC increased considerably. With the deepening of the degree of intervertebral space stenosis, the incidence of type C MDBC increased significantly, whereas that of type A MDBC decreased. In the presence of dorsal osteophytosis, the incidence of type C and D MDBCs significantly decreased, whereas that of type A increased. In the presence of protrusion of the intervertebral disc, the incidence of type B, C, and D MDBCs increased markedly, whereas that of type A MDBC decreased considerably, with cervical degenerative changes combined with spinal canal stenosis. Moreover, the incidence of both type C and D MDBCs increased, whereas that of type A MDBC decreased. Based on the MRI signal characteristics of the dural side of the MDBC, four types of the MDBC were identified. MDBC typing varies dynamically according to population distribution, depending on age and cervical degeneration (degree of intervertebral space stenosis, vertebral dorsal osteophytosis formation, simple protrusion of intervertebral disc, and cervical degeneration changes combined with spinal canal stenosis, except for the degree of protrusion of the intervertebral disc and the degree of spinal canal stenosis); however, it is not influenced by sex.


Assuntos
Músculos do Pescoço , Pescoço , Animais , Humanos , Constrição Patológica , Estudos Retrospectivos , Pescoço/anatomia & histologia , Músculos do Pescoço/anatomia & histologia , Vértebras Cervicais/anatomia & histologia , Dura-Máter/anatomia & histologia , Imageamento por Ressonância Magnética , Mamíferos
13.
World Neurosurg ; 183: e871-e876, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38218446

RESUMO

BACKGROUND: Watertight closure of dura mater after intracranial surgery can avoid cerebrospinal fluid leakage and central nervous system infection and herniation. When primary closure is not possible, the pericranium is the preferential choice. When it is not available, a dural substitute becomes necessary. Bovine pericardium treated with polyethylene glycol and ethanol is herein tested as a dural substitute. METHODS: A pilot study comparing bovine pericardium with pericranium in supratentorial neurosurgery was performed. RESULTS: Twenty patients were initially allocated into a bovine pericardium group (group 1) or a pericranium group (group 2). Three patients from group 1 and 2 from group 2 had a loss of follow-up, being excluded. In the remaining 15 patients, epidemiological analysis demonstrated a male:female ratio of 3:4 and 4:4 for groups 1 and 2. Ages varied from 28 to 68 (Mean = 49.6) in group 1 and 40-80 (Mean = 61.2) in group 2, with a mean difference of 11.68 years (P = 0.09). Two cases of surgical site infection and 1 of hydrocephalus were observed. Although the calculated relative risk for complications was higher in group 1 (Relative Risk = 1.08), Fisher exact test demonstrated no statistically significant difference between groups (P = 1.00). Procedure mean time was 23 minutes and 11 seconds in group 1 versus 27 minutes and 55 seconds in group 2 (P = 0.47). Mean graft area was 13.17 and 6.23 cm2 in groups 1 and 2 (P = 0.02). CONCLUSIONS: Bovine pericardium treated with polyethylene glycol and ethanol was comparable to pericranium as a dural substitute. More studies are encouraged to certify our findings.


Assuntos
Neurocirurgia , Humanos , Masculino , Bovinos , Animais , Feminino , Projetos Piloto , Etanol/uso terapêutico , Polietilenoglicóis , Procedimentos Neurocirúrgicos/métodos , Dura-Máter/cirurgia , Complicações Pós-Operatórias/cirurgia
14.
J Exp Med ; 221(2)2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38193859

RESUMO

The central nervous system (CNS) tightly regulates access of circulating immune cells. Immunosurveillance is therefore managed in the meninges at the borders of the CNS. Here, we demonstrated that mural cells, which include pericytes and smooth muscle cells, decreased coverage around blood vessels in the dura, the outermost layer of the meninges, and upregulated gene pathways involved in leukocyte migration in presymptomatic experimental autoimmune encephalomyelitis (EAE). Partially depleting mural cells promoted the trafficking of CNS antigen-specific T cells to the dura in a process that depended on resident antigen-presenting cells, thereby increasing susceptibility to passive EAE. Mechanistically, mural cells physically contacted macrophages in the dura and transferred cytoplasmic components, including processing bodies (RNA granules shown to reprogram transcriptomes), which were critical to suppress antigen-dependent T helper (TH) cell activation and TH17 differentiation. Our study revealed a mechanism by which mural cell-macrophage interactions regulate the trafficking of CNS antigen-specific T cells to the dura.


Assuntos
Dura-Máter , Encefalomielite Autoimune Experimental , Animais , Sistema Nervoso Central , Meninges , Macrófagos , Pericitos
15.
Acta Neurochir (Wien) ; 166(1): 28, 2024 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-38261164

RESUMO

Technological (and also methodological) advances in neurosurgery and neuroimaging have prompted a reappraisal of Simpson's grading of the extent of meningioma resections. To the authors, the published evidence supports the tenets of this classification. Meningioma is an often surgically curable dura-based disease. An extent of meningioma resection classification needs to account for a clinically meaningful variation of the risk of recurrence depending on the aggressiveness of the management of the (dural) tumor origin.Nevertheless, the 1957 Simpson classification undoubtedly suffers from many limitations. Important issues include substantial problems with the applicability of the grading paradigm in different locations. Most notably, tumor location and growth pattern often determine the eventual extent of resection, i.e., the Simpson grading does not reflect what is surgically achievable. Another very significant problem is the inherent subjectivity of relying on individual intraoperative assessments. Neuroimaging advances such as the use of somatostatin receptor PET scanning may help to overcome this central problem. Tumor malignancy and biology in general certainly influence the role of the extent of resection but may not need to be incorporated in an actual extent of resection grading scheme as long as one does not aim at developing a prognostic score. Finally, all attempts at grading meningioma resections use tumor recurrence as the endpoint. However, especially in view of radiosurgery/radiotherapy options, the clinical significance of recurrent tumor growth varies greatly between cases.In summary, while the extent of resection certainly matters in meningioma surgery, grading resections remains controversial. Given the everyday clinical relevance of this issue, a multicenter prospective register or study effort is probably warranted (including a prominent focus on advanced neuroimaging).


Assuntos
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Procedimentos Neurocirúrgicos , Dura-Máter , Neuroimagem , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Estudos Multicêntricos como Assunto
16.
No Shinkei Geka ; 52(1): 29-37, 2024 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-38246667

RESUMO

In most microvascular decompression surgeries, surgical maneuvers are performed within normal anatomical structures without any neoplasms. Thus, detailed anatomical knowledge is essential to perform safe and efficient procedures. "Rule of 3" by Rhoton AL Jr. is helpful for understanding not only the anatomy of the posterior fossa but also the three neurovascular compression syndromes. The cerebellar arteries and posterior fossa veins have substantial variability, but a basic understanding of their typical patterns is useful to explore individual cases. To use adequate surgical approaches through the cerebellar tentorial or petrosal surface in individual trigeminal neuralgia surgeries, anatomical knowledge of the bridging veins on the tentorial(the bridging veins into the tentorial sinus)and petrosal surfaces(the superior petrosal vein)is crucial. Fissure openings help to minimize cerebellar retraction, similarly to the sylvian fissure dissection in supratentorial surgeries.


Assuntos
Veias Cerebrais , Cirurgia de Descompressão Microvascular , Humanos , Cerebelo/cirurgia , Dura-Máter , Síndrome
17.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38241431

RESUMO

CASE: A 61-year-old woman with recurrent left L5 radiculopathy underwent revision L4-5 decompression complicated by incidental durotomy requiring primary repair. Postoperative course was complicated by wound drainage and headache. Repeat magnetic resonance imaging demonstrated cerebrospinal fluid dissecting a plane deep to the dura mater but superficial to the arachnoid, with the collection compressing the cauda equina in an atypical horizontal and linear fashion. Nonoperative treatment was ineffective, and she required revision decompression and dural repair. CONCLUSION: Spine surgeons should recognize this finding on postoperative imaging as a potential sign of an incomplete dural repair necessitating return to the operating room.


Assuntos
Cauda Equina , Feminino , Humanos , Pessoa de Meia-Idade , Cauda Equina/cirurgia , Cauda Equina/patologia , Dura-Máter/cirurgia , Dura-Máter/patologia , Imageamento por Ressonância Magnética
18.
J Headache Pain ; 25(1): 9, 2024 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-38243174

RESUMO

BACKGROUND: Monoclonal antibodies directed against the neuropeptide calcitonin gene-related peptide (CGRP) are effective in the prevention of chronic and frequent episodic migraine. Since the antibodies do not cross the blood brain barrier, their antinociceptive effect is attributed to effects in meningeal tissues. We aimed to probe if such an antibody can be visualized within the dura mater and the trigeminal ganglia following its administration to rats and to examine if the activity of the trigeminovascular nocisensor complex is influenced by this treatment. METHODS: Effects of the anti-CGRP antibody galcanezumab on the trigeminovascular nocisensor complex was examined by measuring release of sensory neuropeptides and histamine from the rat dura mater. Deposits of galcanezumab were visualized by fluorescence microscopy in the trigeminal ganglion and the dura mater. RESULTS: Fluorophore-labelled galcanezumab was detected in the dura mater and the trigeminal ganglion up to 30 days after treatment affirming the long-lasting modulatory effect of this antibody. In female rats, seven days after systemic treatment with galcanezumab the capsaicin-induced release of CGRP was decreased, while that of substance P (SP) was increased in the dura mater. In control rats, release of the inhibitory neuropeptide somatostatin (SOM) was higher in females than in males. Stimulation with high concentration of KCl did not significantly change the release of SOM in control animals, while in rats treated with galcanezumab SOM release was slightly reduced. Galcanezumab treatment also reduced the amount of histamine released from dural mast cells upon stimulation with CGRP, while the effect of compound 48/80 on histamine release was not changed. CONCLUSIONS: Galcanezumab treatment is followed by multiple changes in the release of neuropeptides and histamine in the trigeminal nocisensor complex, which may contribute to the migraine preventing effect of anti-CGRP antibodies. These changes affecting the communication between the components of the trigeminal nocisensor complex may reduce pain susceptibility in migraine patients treated with CGRP targeting monoclonal antibodies.


Assuntos
Anticorpos Monoclonais Humanizados , Peptídeo Relacionado com Gene de Calcitonina , Transtornos de Enxaqueca , Humanos , Masculino , Ratos , Feminino , Animais , Peptídeo Relacionado com Gene de Calcitonina/farmacologia , Histamina , Dura-Máter , Transtornos de Enxaqueca/tratamento farmacológico , Gânglio Trigeminal , Anticorpos Monoclonais/farmacologia
19.
Clin Anat ; 37(2): 154-160, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37144299

RESUMO

This paper studied the arachnoid of the chiasmatic cistern (CC) and the methods for increasing the exposure of the CC from an endoscopic perspective. Eight anatomical specimens with vascular injection were used for endoscopic endonasal dissection. The anatomical characteristics of the CC were studied and documented, and anatomical measurements were collected. The CC is an unpaired five-walled arachnoid cistern located between the optic nerve, optic chiasm, and the diaphragma sellae. The average exposed area of the CC before the anterior intercavernous sinus (AICS) was transected was 66.67 ± 33.76 mm2 . After the AICS was transected and the pituitary gland (PG) was mobilized, the average exposed area of the CC was 95.90 ± 45.48 mm2 . The CC has five walls and a complex neurovascular structure. It is located in a critical anatomical position. The transection of the AICS and mobilization of the PG or the selective sacrifice of the descending branch of the superior hypophyseal artery can improve the operative field.


Assuntos
Aracnoide-Máter , Espaço Subaracnóideo , Humanos , Aracnoide-Máter/cirurgia , Endoscopia , Dura-Máter , Cavidades Cranianas
20.
World Neurosurg ; 181: e493-e503, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37898275

RESUMO

BACKGROUND: To assist doctors in making better treatment decisions and improve patient prognosis, it is important to determine which therapy modalities are suitable for various forms of idiopathic hypertrophic cranial pachymeningitis (IHCP). METHODS: All cases were received from the hospital medical record system, and some follow-up information was gathered through telephone follow-up. RESULTS: A total of 26 patients, 14 men and 12 women, with ages ranging from 20 to 73 years and a mean of 47.42 years, were included in the research. Regular types were less likely to recur than irregular and nodular types, focal types were less likely to recur than diffuse types, and corticosteroid-refractory types were more likely to recur than corticosteroid-sensitive types. CONCLUSIONS: The extent and shape of the lesion and susceptibility to corticosteroids are potential factors that could influence recurrence. Futhermore, this paper also proposes the fibroblasts as a new therapeutic target which may improve the quality of prognostic survival of patients.


Assuntos
Meningite , Masculino , Humanos , Feminino , Meningite/patologia , Corticosteroides/uso terapêutico , Tomada de Decisões , Fibroblastos/patologia , Hipertrofia/patologia , Imageamento por Ressonância Magnética , Dura-Máter/patologia
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