[The 3d spinal space, subdural or epiarachnoid space. Its application to the treatment of pain].
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Results for “Subdural Space”
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Local hypercoagulative activity precedes hyperfibrinolytic activity in the subdural space during development of chronic subdural haematoma from subdural effusion.
The involvement of coagulation and fibrinolysis in the development of chronic subdural haematoma (CSH) from subdural effusion was investigated. Subdural fluid and venous blood samples were obtained from 34 patients with CSH and 9 patients with subdural effusion, and analyzed using enzyme-linked immunosorbent assays for thrombin-antithrombin III complex (TAT), prothrombin fragment F1 + 2 (F1 + 2), tissue factor, tissue factor pathway inhibitor (TFPI) and D-dimer. CSH was classified into the layering type, believed to be active, and other types according to x-ray computed tomography. All markers in the blood of both patient groups were similar to the values of normal subjects. Levels of TAT and F1 + 2 were much higher in the subdural fluid than in the blood of patients with CSH (P < 0.001, P < 0.001) and with subdural effusion (P < 0.05, P < 0.05). The level of D-dimer in the subdural fluid was significantly higher than in the blood (P < 0.001) in patients with CSH, but not in patients with subdural effusion. All markers in the subdural fluid of layering type CSH, except TFPI, were significantly higher than in the other types (P < 0.05). Local hypercoagulative activity in the subdural space is present in subdural effusion and precedes hyperfibrinolytic activity in CSH. Thrombin generation as indicated by TAT and F1 + 2 might be involved in the development of CSH. Propagation of CSH may be modulated by the coagulation system including the extrinsic pathway and fibrinolysis.
Adult↗
The subdural space interpreted as a cellular layer of meninges.
The subdural region within the cranial meninges is examined in guinea pigs by electron microscopy. The fine structures of the arachnoid membrane and dura are described separately in specimens that have been isolated from each other during removal from the cranial cavity. In addition, the fine structure of the intact dura-arachnoid is described, where the subdural space would be present in an undisrupted state. Lastly, the inner surface of the dura and the outer surface of the arachnoid membrane are examined at the point of separation between the two specimens where the dura is reflected from the arachnoid by experimental dissection. From these observations morphologic criteria are established for identifying the constituents and boundaries of the subdural space and for explaining mechanisms in the histogenetic process of "opening" or enlarging this space. The morphologic identity of the classic subdural space is reinterpreted in light of the findings. The subdural space, traditionally described as a fluid-filled potential cavity existing in an extracellular compartment, is not apparent in the guinea pig. Instead, fragile cells designated as light cells occupy the compartment between the dura and arachnoid, with very little extracellular space available. Experimental opening of the subdural space occurs, significantly, along pathways extending by fracture through the cytoplasm and intercellular separation of these light cells rather than by enlargement of a preexisting mesothelial-lined intercellular space between these cells and the true arachnoid cells. Cytoplasmic fine structure of light cells suggests a close kinship with cells in the meningeal layer of the dura. The functional significance of the light cells and their possible role in subdural hematomas is discussed.
Animals↗
Continuous irrigation-drainage of the subdural space for the treatment of chronic subdural haematoma. A prospective clinical trial.
Thirty seven adult patients which chronic subdural haematoma were randomized into two groups. Eighteen patients served as controls and underwent evacuation of the haematoma via burr holes and a gravity dependent closed-system drainage. Nineteen patients comprised the study group. These patients had a continuous irrigation-drainage system installed in an attempt to facilitate the removal of fibrinolytic substances present in the haematoma fluid and to try to reduce the rate of rebleeding from the haematoma membranes. No differences were found between the pre- and post-operative clinical status, haematoma volumes and the degree of CT changes between the two groups. The complication rate was similar in the two groups. One patient in the study group and three patients in the control group required an extended period of drainage (24-48 hours) prior to the removal of the drains. All patients improved following the procedures. Within 30 days post the initial evacuation of the chronic subdural haematoma, re-operation was required in only one patient in the study group as opposed to four of the controls. This difference was not however statistically significant. When the need for re-operation was combined with the need for extended drainage period, a significant difference was shown in favour of the study group. These results indicate that drainage combined with continuous irrigation of the subdural space does not affect the clinical outcome of the patients, but significantly reduces the frequency of inadequate drainage of the haematoma and prevents longer drainage periods and repeated operations.
Aged↗
The origin of the spinal subdural space: ultrastructure findings.
UNLABELLED: Previous studies of samples from cranial meninges have created doubts about the existence of a virtual subdural space. We examined the ultrastructure of spinal meninges from three human cadavers immediately after death to see whether there is a virtual subdural space at this level. The arachnoid mater had two portions: a compact laminar portion covering the dural sac internal surface and a trabecular portion extending like a spider web around the pia mater. There was a cellular interface between the laminar arachnoid and the internal layer of the dura that we called the dura-arachnoid interface. There was no subdural space in those specimens where the dura mater was macroscopically in continuity with the arachnoid trabecules. In the specimens where the dura mater was separated from the arachnoid, we found fissures in between the neurothelial cells that extended throughout the interface. We hypothesize that the subdural space would have its origin within the dura-arachnoid interface when the neurothelial cells break up, creating in this way a real subdural space. IMPLICATIONS: The subdural space was not seen under transmission electron microscopy in samples of human spinal meninges where surgical manipulation was avoided. Scanning electron microscopy in other samples showed the presence of broken neurothelial cells giving up fissures that extended along the dura-arachnoid interface. These findings may explain the origin of a real subdural space.
Arachnoid↗
The subdural space.
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Anesthesia, Spinal↗
The dissemination of fragments of cerebellar tissue into the spinal subarachnoid and subdural spaces following severe head injury--a report of two cases.
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Adult↗
[Light and electron microscopic studies on the subdural space, the subarachnoid space and the arachnoid membrane].
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Aged↗
The subdiaphragmatic cistern of the hypophyseal infundibular stem. I. Relationship to the subdural space and the cavernous sinuses.
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Animals↗
[A case of intracranial infectious granuloma extending into subcutaneous and subdural space].
A case of intracranial infectious granuloma extending into subcutaneous and subdural space mimicking malignant bone tumor was reported. A 49-year-old male was admitted to our service with complaint of left frontal subcutaneous and bone tumor. Neurological examination demonstrated mild disorientation only except for pre-existeng Schizophrenia. CT scan and Gadolinium-enhanced MRI revealed left frontal intraosseous and subdural mass accompanied with remarkable edema. Left frontal bone was destructed by this mass. However, inflammatory sign nor malignant tumor could be observed and left frontal craniotomy and removal of the tumor was performed. The tumor was solid, elastic hard and existing from intra-osseous, epidural and subdural space compressing the cortex. No abscesss cavity could be found. Histological examination revealed infectious granuloma accompanied by remarkable neutrophil infiltration only. The patient showed good post-operative course, and returned to previous condition, pre-existeng Schizophrenia only. Intracranial infectious granuloma extending into subcutaneous and subdural space destructing the bone was rare condition. From literature, similar cases could be found in granuloma arising from osteomyelitis. In this case, destructed bone beneath the epi- and subdural tumor support this route of infection.
Brain Diseases↗
Migration of adult Elaphostrongylus rangiferi (Nematoda: Protostrongylidae) from the spinal subdural space to the muscles of reindeer (Rangifer tarandus).
To trace the intrahost migration of adult (fifth-stage) Elaphostrongylus rangiferi 9 reindeer calves were fed infective larvae and examined for worms 48-250 days postinfection. The average length of worms recovered increased asymptotically with time. Gravid females and adult males were recovered from 52 days postinfection (d.p.i.), and the fraction made up by these categories increased with time. Immature females and subadult males were recovered as late as 161 d.p.i. Nematodes were recovered from the spinal subdural space 48-161 d.p.i., from the cranial subdural space 48-90 d.p.i., and from the musculature 90-250 d.p.i. Immature females were found in the spinal subdural space and the cranial subdural space, whereas gravid females were found also in the musculature with an increasing fraction with time. Subadult and adult males were found in all 3 sites but with an increasing fraction of adults from the spinal canal to the cranium to the musculature.
Animals↗
[Migration of subduro-peritoneal shunt into the subdural space of an infant (author's transl)].
A ten-month-old baby was admitted to our clinic with the diagnosis of bilateral chronic subdural hematomas. He had complained of general convulsion during the past 3 months. Evacuation of hematomas was performed on both sides through burr holes in the parietal region. Several weeks following the evacuation of hematomas, subduroperitoneal (S-P) shunting operation was further performed bilaterally for the collection of fluid in the subdural spaces, using a "Pudenz" shunting catheter with a reservoir. The catheter was fixed at the connector of the reservoir and the peritoneal catheter by several silk sutures to the epicranium. Three weeks after S-P shunting operation the right shunting system was not felt on his head on palpation, and the abnormal high density spots were shown inside the right subdural space on CT. The right craniotomy revealed that the whole shunting system was located in the right subdural space. Technical problems of the shunting operation and the several factors of the patient which may contribute to such a rare complication of this surgical procedure are briefly discussed.
Cerebrospinal Fluid Shunts↗
On the question of a subdural space.
The structure of the meninges, with particular attention to the architecture of the inner portions of the dura mater and the arachnoid mater, has been reviewed in reference to the probable existence of a "subdural" space. The dura is composed of fibroblasts and large amounts of extracellular collagen. The innermost part of the dura is formed by the dural border cell layer. This layer is characterized by flattened cells with sinuous processes, extracellular spaces containing an amorphous material, and the presence of junctions between its cells. The dural border cell layer is continuous with the inner (meningeal) portions of the dura and may be attached to the underlying arachnoid by an occasional cell junction. The arachnoid consists of an outer part, the arachnoid barrier cell layer, and an inner portion, the arachnoid trabeculae which bridge the subarachnoid space. Arachnoid barrier cells are electron-lucent, closely apposed to each other, and joined by many cell junctions; in this layer there is little extracellular space and essentially no intercellular material. Arachnoid trabecular cells cross the subarachnoid space in a random manner, have extracellular collagen associated with their flattened processes, and form structures of variable shapes and sizes. There is no evidence of an intervening space between the arachnoid barrier cell layer and the dural border cell layer that would correlate with what has been called the subdural space. When a tissue space is created in this general area of the meninges it is the result of tissue damage and represents, in most instances, a cleaving open of the dural border cell layer. In this situation, extracellular spaces in the dural border cell layer are enlarged, cell junctions are separated, and it is probable that cell membranes are damaged. A survey of reports describing the morphology of the inner and outer capsule of so-called subdural hematomas in humans reveals that dural border cells are found in both parts of the capsule. Also, experimental infusion of blood into this portion of the meninges in animals frequently dissects open the dural border cell layer. These data support the view that what has been called a subdural hematoma is most frequently a lesion found within the layer formed by dural border cells. It is suggested that the so-called subdural space is not a "potential" space since the creation of a cleft in this area of the meninges is the result of tissue damage. In this respect it shares no similarities with legitimate potential spaces (i.e., serous cavities) found at other locations in the body.(ABSTRACT TRUNCATED AT 400 WORDS)
Arachnoid↗
Injection into the extra-arachnoid subdural space. Experience in the treatment of intractable cervical pain and in the conduct of extradural (epidural) analgesia.
The anatomy and radiological appearances of the subdural space in the cervical region are described. Recognition of this space facilitates neurolytic injections for severe cancer pain in the distribution of the cervical nerve roots. The subdural space may have significance also in explaining the extensive sensory block which follows a delayed or 'massive' lumbar extradural injection.
Analgesics↗
[Electron microscopic study of the process of the removal of autogenous blood erythocytes beyond the limits of the subdural space].
The internal plate of the dura mater and arachnoidea of the dob brain was studied by electron microscopy after introducing 0.3--0.5 ml of the autogenous blood into the subdural space. The arachnoidea of the excretory channels and structural elements of the internal plate of the dura mater (cells of the internal covering layer, the collagen fibril and microfibril layer, the wall of the blood capillaries of the internal capillary network) involve the morphological substratum of the liquor-blood barrier-I between the liquor and blood of the blood capillaries of the internal capillary network of the dura mater. It was established that red cells of the subdural space penetrate the thickness of the dura mater, where they concentrate around blood capillaries of the internal capillary network, rather than penetrate into the arachnoidea.
Animals↗
[Does the subdural space exist?].
A potential space between the dura mater and the arachnoides is thought to exist, occupied by a serous fluid and called the subdural space. Recent studies may change this classical concept, however. The dura-arachnoid complex from the epidural to the arachnoid space is formed by morphologically distinct layers: the dura mater, the subdural compartment and the arachnoid mater, which are made up of different cell types. The dura mater consists of greater and lesser laminae formed mainly of collagen fibers aligned differently. The subdural compartment is formed by a number of so-called "neurothelial cells", which are in close contact with the inner dural layers. These cells are flat and have long interlaced branches. The arachnoides are made of cells grouped in three different layers. The outer layer is the "barrier arachnoid layer". Located just inside the anterior cell plane, this layer is made of less flattened cells that form an epithelial-type tissue, with complex cell-cell junctures surrounded by collagen fibers. The middle layer is the reticular arachnoid, composed of irregularly interlaced cells alternating with collagen fibers and intercellular gaps of varying sizes. The innermost layer, the trabecular arachnoid, is in direct contact with the subarachnoid space. The cells of this layer form strands that contribute to the weblike pattern found in the subarachnoid space. Recently, special techniques for fixing and preparing samples, preserving in situ the anatomical relations between the arachnoides and the dura mater, have allowed us to examine the normal configuration of the subdural space. All samples examined revealed the presence of a cellular plane between the dura mater and the arachnoides, with no evidence of the classically described space. The zone of least resistance in the dura-arachnoid complex was the subdural compartment, which could be torn mainly along intercellular spaces, though cell rupture was also observed, affecting the cytoplasmic membranes of adjacent cells. The subdural space is opened by tearing the subdural compartment between neurothelial cells alongside the collagen fibers of the dura mater. Such a tear can be caused mechanically by injecting air or contrast media, which exert pressure on a laminar structure that tends to separate because it is weaker than neighboring ones.
Animals↗
Arachnoid cyst with spontaneous rupture into the subdural space.
Spontaneous rupture of an arachnoid cyst into the subdural space is an unusual complication. Only six cases have been reported in the literature. We report here an additional case and review the literature concerning arachnoid cysts. The possible pathogenesis of this condition is discussed.
Acute Disease↗
Histological reaction to various conductive and dielectric films chronically implanted in the subdural space.
Thirty different test patches of various thin film materials were chronically implanted in the subdural space of cats to determine their suitability as components for proposed neuroprosthetic devices. In particular, materials employed by the microelectronics industry were screened, and reactions were found to be quite dependent on specific formulations or surface preparations of otherwise similar materials. A nonspecific but severe complication of pressure necrosis under thin films that spontaneously roll and curl in vivo was noted.
Animals↗