The fine anatomy of the human spinal meninges

1988 ◽  
Vol 69 (2) ◽  
pp. 276-282 ◽  
Author(s):  
David S. Nicholas ◽  
Roy O. Weller
Keyword(s):  
Spinal Cord ◽  
Blood Vessels ◽  
Transverse Section ◽  
Human Cerebral Cortex ◽  
Pia Mater ◽  
Content Type ◽  
Inner Aspect ◽  
Dentate Ligament ◽  
Arachnoid Mater ◽  
Fine Print

✓ The fine anatomy of the human spinal meninges was examined in five postmortem spinal cords taken within 12 hours after death from patients aged 15 months to 46 years. Specimens of spinal cord were viewed in transverse section and from the dorsal and ventral aspects by scanning electron microscopy. Transverse sections of spinal cord and meninges were also examined by light microscopy. The arachnoid mater was seen to be closely applied to the inner aspect of the dura. An intermediate fenestrated leptomeningeal layer was observed attached to the inner aspect of the arachnoid mater and was reflected ventrally to form a series of dorsal septa. As it arborized laterally over the surface of the cord to surround nerves and blood vessels, the intermediate layer became highly fenestrated but remained distinct from the pia and arachnoid mater. The pia mater appeared to form a continuous layer which was reflected off the surface of the cord to coat blood vessels within the subarachnoid space in a manner similar to that described in the leptomeninges over the human cerebral cortex. Each dentate ligament consisted of a collagenous core which was continuous with the subpial connective tissue and was attached at intervals to the dura; pia-arachnoid cells coated the surface of the dentate ligaments. The present study suggests that the fine anatomy of the human spinal meninges differs significantly from that described in other mammals.

Intraspinal mesenchymal chondrosarcoma

1994 ◽  
Vol 80 (5) ◽  
pp. 928-930 ◽  
Author(s):  
Alok Ranjan ◽  
Geeta Chacko ◽  
Thomas Joseph ◽  
Sushil M. Chandi
Keyword(s):  
Spinal Cord ◽  
Magnetic Resonance ◽  
Dura Mater ◽  
Microscopic Examination ◽  
Mesenchymal Chondrosarcoma ◽  
Pia Mater ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ A 52-year-old man presented with symptoms of progressive cervical radiculomyelopathy. A myelogram showed an intradural block at the C-6 level. Magnetic resonance T1-weighted imaging revealed a hypointense, sausage-shaped mass extending from C-3 to C-6, located posterolaterally on the right side and pushing the spinal cord to the left and anteriorly. At surgery, a mass was found attached solely to the pia mater, with a normal arachnoid and dura mater overlying it. The mass was excised completely and microscopic examination identified a mesenchymal chondrosarcoma. The patient was symptom-free 6 months after surgery.

Postoperative fibrosis after surgical treatment of the porcine spinal cord: a comparison of dural substitutes

2005 ◽  
Vol 2 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Iftikharul Haq ◽  
Yenisel Cruz-Almeida ◽  
Edir B. Siqueira ◽  
Michael Norenberg ◽  
Barth A. Green ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Adverse Effects ◽  
Subarachnoid Space ◽  
Histological Evaluation ◽  
Postoperative Adhesion ◽  
Pia Mater ◽  
Content Type ◽  
Inflammatory Reactions ◽  
Dural Substitute ◽  
Fine Print

Object. Postoperative adhesion- and fibrosis-induced spinal cord tethering is not uncommon and may be associated with delayed clinical sequelae. Multiple dural substitutes have been used in surgery without a full appreciation of the grafts' adverse effects. The authors conducted a comparative animal experimental study to evaluate the degree of chronic inflammatory reactions, adhesions, and fibrosis caused by the use of four dural substitutes—Surgicel, Durasis, DuraGen, and Preclude. Methods. Twenty-six pigs weighing 30 to 40 kg underwent a two-level lumbar laminectomy (a midline durotomy, implantation of a 2-cm dural substitute in the subarachnoid space, and watertight dural closure). After 8 weeks the animals were killed, and two independent neuropathologists blinded to the dural substitute group evaluated several sites along the implants, providing descriptions and quantitative scoring of fibrosis, chronic inflammatory reactions, foreign-body reactions, and spinal cord changes. Kruskal—Wallis one-way analysis of variance for ranks corrected for multiple comparisons was used to examine differences among the materials. Conclusions. The DuraGen dural substitute produced the least amount of inflammation in the subarachnoid space and Preclude generated the most (p < 0.001). Surgicel and DuraGen were completely resorbed on histological sections, but both produced some inflammation, which diminished gradually from the dural implant center. Histological evaluation of the nonresorbed grafts demonstrated that Durasis caused the least degree of inflammatory cell infiltration (p < 0.001). The Preclude dural substitute consistently demonstrated encapsulation and arachnoidal reaction. There was no evidence of implant-related adverse effects on the underlying pia mater and white matter regardless of the substitute type.

Localization of fibrinolytic activity and inhibition of plasmin in the spinal cord of rat, guinea pig, and rabbit

1978 ◽  
Vol 48 (6) ◽  
pp. 1008-1014 ◽  
Author(s):  
Athanasios Smokovitis ◽  
Tage Astrup
Keyword(s):  
Spinal Cord ◽  
White Matter ◽  
Guinea Pig ◽  
Gray Matter ◽  
Spinal Canal ◽  
Fibrinolytic Activity ◽  
Pia Mater ◽  
Content Type ◽  
Additional Area ◽  
Fine Print

✓ Fibrinolytic activity (caused by a plasminogen activator) in the spinal cord was highest in the rat, lowest in the rabbit, and intermediate in the guinea pig. In all species the activity was highest in relation to the pia mater. The central spinal canal was active in the rat and the rabbit, but mostly inactive in the guinea pig. Foci of activity were more numerous in the gray matter than in the white matter corresponding to the greater vascularity of the former. In all species ability to inhibit plasmin was related mainly to the gray matter, with an additional area related to the dura mater. The high fibrinolytic activity of the spinal leptomeninges may play a role in the pathogenesis of hemorrhagic processes related to the spinal cord.

Mechanical properties and function of the spinal pia mater

2004 ◽  
Vol 1 (1) ◽  
pp. 122-127 ◽  
Author(s):  
Hiroshi Ozawa ◽  
Takeo Matsumoto ◽  
Toshiro Ohashi ◽  
Masaaki Sato ◽  
Shoichi Kokubun
Keyword(s):  
Mechanical Properties ◽  
Spinal Cord ◽  
Elastic Modulus ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Pia Mater ◽  
Cross Sectional ◽  
Content Type ◽  
And Function ◽  
Fine Print

Object. The pia mater has received little attention regarding its function in the deformation of the spinal cord under compression. In this study the mechanical properties and function of the spinal pia mater were investigated using three methods. Methods. Spinal cord segments were excised from rabbits. The elastic modulus of the pia mater was measured by performing a tensile test using specimens with the pia mater intact and ones with the pia mater stripped off. The stiffness of the spinal cord was examined by performing a compression test with specimens containing an intact pia mater and ones with a pia mater that was incised at both sides. The cross-sectional area and circumference of the spinal cord were measured on axial views of magnetic resonance images in patients with cervical disc herniations before and after surgery. The pia mater had an elastic modulus of 2300 kPa, which was 460 times higher than that of spinal cord parenchyma. By covering the parenchyma, it tripled the overall elastic modulus of the spinal cord. The pia mater increased the stiffness of the spinal cord and enhanced its shape recovery after removal of the compression. The cross-sectional area of the spinal cord increased after surgery, whereas the circumference of the spinal cord changed little. Conclusions. The pia mater firmly covers the spinal cord and has a high elastic modulus; it therefore provides a constraint on the spinal cord surface. It prevents elongation of the circumference and produces a large strain energy that is responsible for shape restoration following decompression.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

Posterior approach for cervical intramedullary arteriovenous malformation with diffuse-type nidus

1999 ◽  
Vol 91 (1) ◽  
pp. 105-111 ◽  
Author(s):  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Alaa El-Naggar ◽  
Michiharu Morino ◽  
Akimasa Nishio ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Poor Prognosis ◽  
Posterior Approach ◽  
The Other ◽  
Anterior Spinal Artery ◽  
Neural Element ◽  
Feeding Artery ◽  
Diffuse Type ◽  
Content Type ◽  
Fine Print

✓ The treatment of spinal intramedullary arteriovenous malformations (AVMs) with a diffuse-type nidus that contains a neural element poses different challenges compared with a glomus-type nidus. The surgical elimination of such lesions involves the risk of spinal cord ischemia that results from coagulation of the feeding artery that, at the same time, supplies cord parenchyma. However, based on evaluation of the risks involved in performing embolization, together with the frequent occurrence of reperfusion, which necessitates frequent reembolization, the authors consider surgery to be a one-stage solution to a disease that otherwise has a very poor prognosis. Magnetic resonance (MR) imaging revealed diffuse-type intramedullary AVMs in the cervical spinal cords of three patients who subsequently underwent surgery via the posterior approach. The AVM was supplied by the anterior spinal artery in one case and by both the anterior and posterior spinal arteries in the other two cases. In all three cases, a posterior median myelotomy was performed up to the vicinity of the anterior median fissure that divided the spinal cord together with the nidus, and the feeding artery was coagulated and severed at its origin from the anterior spinal artery. In the two cases in which the posterior spinal artery fed the AVM, the feeding artery was coagulated on the dorsal surface of the spinal cord. Neurological outcome improved in one patient and deteriorated slightly to mildly in the other two patients. Postoperative angiography demonstrated complete disappearance of the AVM in all cases. Because of the extremely poor prognosis of patients with spinal intramedullary AVMs, this surgical technique for the treatment of diffuse-type AVMs provides acceptable operative outcome. Surgical intervention should be considered when managing a patient with a diffuse-type intramedullary AVM in the cervical spinal cord.

Traumatic arteriovenous fistula of the vertebral artery with spinal cord symptoms

1977 ◽  
Vol 46 (5) ◽  
pp. 681-687 ◽  
Author(s):  
Chikao Nagashima ◽  
Takashi Iwasaki ◽  
Seiichi Kawanuma ◽  
Arata Sakaguchi ◽  
Akira Kamisasa ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Rapid Improvement ◽  
Direct Closure ◽  
Content Type ◽  
Vertebral Arteriovenous Fistula ◽  
Fine Print

✓ The authors report a case of a traumatic vertebral arteriovenous fistula with spinal cord symptoms. Direct closure of the fistula was followed by rapid improvement.

Split spinal cord malformations in children

1998 ◽  
Vol 88 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Yusuf Ersşahin ◽  
Saffet Mutluer ◽  
Sevgül Kocaman ◽  
Eren Demirtasş
Keyword(s):  
Spinal Cord ◽  
Neurological Deficits ◽  
Single Type ◽  
Type I ◽  
Type Ii ◽  
Content Type ◽  
Spinal Lesion ◽  
The Mean ◽  
Fine Print

Object. The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al. Methods. Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvement was observed in 18 patients. Conclusions. The classification of SSCMs proposed by Pang, et al., will eliminate the current chaos in terminology. In all SSCMs, either a rigid or a fibrous septum was found to transfix the spinal cord. There was at least one unrelated lesion that caused tethering of the spinal cord in 85% of the patients. The risk of neurological deficits resulting from SSCMs increases with the age of the patient; therefore, all patients should be surgically treated when diagnosed, especially before the development of orthopedic and neurological manifestations.

Astrocytomas of the spinal cord in children and adolescents

1985 ◽  
Vol 63 (5) ◽  
pp. 669-675 ◽  
Author(s):  
Ronald Reimer ◽  
Burton M. Onofrio
Keyword(s):  
Spinal Cord ◽  
Histological Grade ◽  
Extended Period ◽  
Spinal Deformities ◽  
Duration Of Symptoms ◽  
Female Ratio ◽  
Content Type ◽  
Orthopedic Procedure ◽  
Male To Female ◽  
Fine Print

✓ The authors review 32 cases of spinal cord astrocytoma in patients under 20 years of age who were treated at the Mayo Clinic between 1955 and 1980. There was a 1.3:1 male to female ratio. Twenty patients were between 6 and 15 years of age at the time of diagnosis. The duration of symptoms prior to definitive diagnosis varied from 5 days to 9 years, with an average of 24 months. The most common symptoms were pain (62.5%), gait disturbance (43.7%), numbness (18.8%), and sphincteric dysfunction (18.8%). The most common neurological findings were a Babinski response (50.0%), posterior column sensory dysfunction (40.6%), and paraparesis (37.5%). A median follow-up period of 8.6 years (range 0.8 to 25.5 years) revealed that the survival time diminished with increased histological grade of the astrocytoma (p < 0.001). The development of postlaminectomy spinal deformities represented a serious postoperative complication. This occurred in 13 patients and was first recognized between 8 and 90 months postoperatively. Six deformities occurred following cervical laminectomy, and eight patients required at least one orthopedic procedure. It is crucial to follow these patients for an extended period of time to watch for postoperative spinal deformities.

Intradural spinal teratoma: evidence for a dysembryogenic origin

1998 ◽  
Vol 89 (5) ◽  
pp. 844-851 ◽  
Author(s):  
Joseph L. Koen ◽  
Roger E. McLendon ◽  
Timothy M. George
Keyword(s):  
Spinal Cord ◽  
Germ Cells ◽  
Primordial Germ Cells ◽  
Split Cord Malformation ◽  
Rare Tumor ◽  
Content Type ◽  
Fine Print

✓ Intradural spinal teratoma is a rare tumor that can be associated with dysraphic defects. Although the origin of these tumors is traditionally thought to be secondary to primordial germ cells misplaced early in embryogenesis, the pathogenesis of intraspinal teratoma remains unclear. The authors present a series of patients in whom an intradural teratoma arose at the same site as a developmental spinal cord abnormality, including a split cord malformation, myelomeningocele, and lipomyelomeningocele. It is postulated that these lesions were the result of a dysembryogenic mechanism and were not neoplastic.

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