324,698 research outputs found
Double dural spinal sheath:a cadaveric case report
Get PDFA previously unreported variation in the anatomy of the spinal dural sheath was observed during routine cadaveric dissection, consisting of a duplication of the dural layer, with layers adherent throughout their length. The double dural sheath completely enveloped the spinal cord and nerve roots, and extended from C2 to L5: both layers were of similar thickness to a single dural sheath. Duplication of the dura mater in the form of two complete dural sheaths has not been previously observed and/or reported in a cadaveric study. However, areas of localised duplication of the ventral aspect of the dural sheath have been observed during intra-operative dissection, particularly in association with idiopathic herniation of the spinal cord. Complete duplication of the spinal dura mater is of clinical interest in spinal surgery, particularly in relation to idiopathic spinal cord herniation. © IJAV. 2010; 3: 41–43
Embolization of Spinal Dural Arteriovenous Fistulae Using a Nonadhesive Liquid Embolic Agent Delivered Via a Dual-Lumen Balloon Catheter
No full textA spinal dural arteriovenous fistula is the most common type of spinal vascular malformation. The principal aim of endovascular treatment is to occlude the fistula site and the proximal part of the draining vein. However, this is not always possible because selective catheterization can be difficult in patients with tortuous feeding arteries, and there is a risk of liquid embolic agent reflux. Herein, we present a novel technique. We use a dual-lumen balloon catheter to inject a liquid embolic agent into the fistula. The pre-inflated balloon prevents proximal reflux and also engages in forward pushing that augments distal penetration of the embolic agent. An absolute prerequisite is a lack of radiculomedullary branches arising from the same segmental feeding artery; careful angiographic examination is mandatory. Use of the dual-lumen balloon catheter technique when long tortuous feeding arteries supply the spinal dural arteriovenous fistula ensures safe and successful embolization with a low risk for complications. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022
Brain arteriovenous malformations presenting with haemorrhage
No full textIncludes bibliographical references
Anterior fossa dural arteriovenous malformation
No full textThe case of a dural arteriovenous malformation (DAVM) fed by the anterior athmoidal artery in the anterior cranial fossa is reported. The patient was examined by arteriography and magnetic resonance imaging. The nidus was located in the region of the right cribiform plate and venous drainage was through pial veins into the superior sagittal sinus. The lesion was surgically treated. The etiology, syínpiomatology and surgical treatment of this rare type of vascular malformation are discussed.Presentamos un caso de malformación arterio-venosa dural (MAVD) a partir de ambas arterias etmoidales anteriores, diagnosticada mediante RNM y angiografía. El nidus estaba situado a nivel de la lámina cribosa derecha, con drenaje a través de las venas piales trombosadas hasta el seno longitudinal superior. Se extirpó completamente durante el acto quirúrgico, sin secuelas. Se discuten la etiología, la clínica y las posibilidades de tratamiento quirúrgicoDepto. de CirugíaFac. de MedicinaTRUEpu
Failed dural puncture during needle-through-needle combined spinal–epidural anesthesia: a case series
No full textA Ram Doo,1,2 Yu Seob Shin,2,3 Jin-wook Choi,1 Seonwoo Yoo,1 Sehrin Kang,1 Ji-seon Son1,2 1Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, South Korea; 2Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea; 3Department of Urology, Chonbuk National University Medical School, Jeonju, South Korea Objective: Combined spinal–epidural (CSE) anesthesia is a widely used neuraxial anesthetic technique. In clinical practice, failed dural puncture during needle-through-needle technique occasionally occurs, with incidence of 5%–29%. We radiologically evaluated four cases of failed dural puncture during needle-through-needle CSE anesthesia. Case series: Four patients received CSE anesthesia for elective orthopedic surgery. CSE procedures were performed in the same manner using a CSE device for needle-through-needle technique. An epidural needle was inserted in midline at L4/5 interspaces using loss of resistance to air whilst patients lay in the lateral decubitus position. The spinal needle was then inserted through the epidural needle for subarachnoid block, however, negative cerebrospinal flow was identified. Subsequently, radiographic imaging using C-arm fluoroscopy was performed to evaluate the status of needles. We found that epidural needles were considerably deviated from the midline, while spinal needles exited epidural needles, not through back holes, but through the Tuohy curve in three patients. In one patient, when the spinal needle was inserted to 12 mm, the anesthesiologist felt the needle touching the bony structure. The spinal needle was in contact with the superior articular process of the fifth lumbar vertebra, which was confirmed by C-arm radiography. Conclusion: Excessive paramedian deviation of the epidural needle may affect dural puncture during needle-through-needle CSE technique. Moreover, wrong passage of the spinal needle through Tuohy curve instead of the back hole, may contribute to failure of dural puncture. Keywords: combined spinal–epidural anesthesia, dural puncture, fai
Magnitude of dural tube compression does not show a predictive value for symptomatic lumbar spinal stenosis for 1-year follow-up: a prospective cohort study in the community
No full textKoji Otani, Shin-ichi Kikuchi, Takuya Nikaido, Shin-ichi Konno Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan Background: The North American Spine Society states that lumbar spinal stenosis (LSS) is a clinical syndrome, and there is insufficient evidence to make a recommendation for or against a correlation between clinical symptoms or function and the presence of anatomic narrowing of the spinal canal on MRI. The main purpose of this study was to assess the influence of the magnitude of dural tube compression on MRI on LSS symptoms at the cross-sectional and 1-year follow-up. Methods: This was a prospective cohort study of 459 participants who were assessed for LSS using a questionnaire and conventional MRI of the lumbar spine. After 1 year, 335 subjects (follow-up rate 73.0%) were assessed for LSS using the same questionnaire. The time course of the clinical subjective symptoms of LSS and the relationship between the said symptoms of LSS and magnitude of dural tube compression on MRI were analyzed in a cross-sectional and longitudinal fashion. Results: 1) The dural sac cross-sectional area (DCSA) decreased with age. 2) Severe dural tube compression had a strong influence on the presence of symptomatic LSS; however, 40%–70% of participants with severe dural tube compression did not show clinical symptoms of LSS. 3) At the 1-year follow-up, >50% of the LSS-positive participants in the initial year were reclassified as LSS negative, and 10% of the LSS-negative participants were reclassified as LSS positive. 4) The magnitude of the DCSA on MRI did not directly affect the presence of LSS at the 1-year follow-up. Conclusion: LSS symptoms were changeable. Anatomical dural tube compression on MRI did not predict the presence of clinical LSS symptoms at the 1-year follow-up. Keywords: lumbar spinal stenosis, epidemiology, natural history, quality of life, prognostic factors, comorbidities, cross-sectional area, MR
Rapidly progressive cognitive impairment in a patient with high flow dural arteriovenous fistulas, cerebral sinus thrombosis and protein S deficiency
No full textDural arteriovenous fistula (DAVF) may present with a variety of neurological symptoms, ranging from tinnitus to fatal hemorrhage. We report a case of rapidly progressive cognitive impairment due to cerebral venous engorgement that reversed after endovascular treatment in a patient with DAVF, cerebral sinus thrombosis and protein S deficiency. DAVF may be a cause of vascular cognitive impairment and should be considered particularly in cases with a rapidly progressive course because they are potentially treatable
Meningioma in Lateral Cerebellomedullary Cistern without Dural Attachment
No full textAbstractIntracranial meningiomas without dural attachment are rare and posterior cranial fossa meningiomas without dural attachment are rarer. Such meningiomas are thought to arise from arachnoid cap cells in pial membrane, tela choroidea, or choroid plexus. MRI is the best imaging modality for the diagnosis of meningiomas and typically shows an enhancing, dural based, extra-axial soft tissue mass with a characteristic dural tail. Meningioma without dural attachment should be suspected if the MRI shows a space-occupying lesion having features of a meningioma but without a dural base and dural tail. We report a case of meningioma in the lateral cerebellomedullary cistern without dural attachment.</jats:p
Involvement of kainate glutamate receptors in the modulation of neuronal transmission in brain areas involved in migraine pathophysiology
No full textMigraine pathophysiology is thought to involve activation of the trigeminal fibres which
innervate dural structures. The nociceptive inflow from the meninges is relayed to the
trigeminocervical complex (TCC), before ascending to higher brain areas, including the
thalamus. Glutamate is implicated in the transmission of the nociceptive information
and thus an increased understanding of the nature and effects of glutamate receptors
activation has major implications in migraine pathophysiology and treatment. Here the
role of kainate receptors, a member of the ionotropic glutamate receptors subfamily,
was investigated in relaying sensory information upon activation of the
trigeminovascular system.
In order to study the role of kainate receptors on the periphery, we used the
neurogenic dural vasodilation (NDV) model, in which electrical stimulation of the dura
mater causes reproducible vasodilation, due to calcitonic gene-related peptide (CGRP)
release. In this set of experiments kainate receptor activation but not blockade was
effective in inhibiting NDV. Vasodilation induced by systemic administration of CGRP
was not changed by administration of a kainate receptor agonist.
In the TCC, local application by microiontophoresis of a selective kainate
receptor antagonist on second order neurons which were excited by meningeal electrical
stimulation, caused dual effects; 50% of the neurons tested were inhibited, whereas in a
second subpopulation, activation in response to meningeal stimulation was facilitated.
However, in all neurons tested, post-synaptic activation in response to kainate receptor
agonists application was selectively inhibited.
Microiontophoretic ejection of a kainate receptor antagonist in the
ventroposteromedial thalamus (VPM) was able to inhibit cell firing in response to dural
stimulation, as well as post-synaptic firing in response to kainate receptor activation.
Both effects were reversed when the kainate receptor antagonist was co-ejected with a
5-HT1B receptor antagonist.
We also carried electrophysiology studies in both the TCC and the VPM nucleus
in order to compare the effects of the clinically active kainate receptor antagonist
LY466195. Systemic and local application of LY466195 was able to inhibit cell firing
in response to dura mater stimulation in both the TCC and VPM nucleus. Moreover,
further to the kainate binding, a significant action of the compound on N-methyl-Daspartate
receptors was observed
Foreign Body Granuloma Mimicking Upper Cervical Spinal Mass after Dural Repair with Tachocomp: A Case Report
No full textThe common indications of dura mater repair are injuries caused by trauma, neoplasms, surgical complications and congenital spinal dysraphism such as meningomyelocele or encephalocele. Dural grafting is done to recreate the dural barrier and avoid the possible postoperative complications. Autografts derived from periosteum, fascia, muscle and fat. The disadvantages of autografts are their small size and esthetic complaints. To overcome the disadvantages synthetic materials might be used in duroplasty. Here we present a 3-year-old girl who developed muscle weakness in the upper and lower extremities caused by foreign body granuloma mimicking malignancy in the cervical spinal cord after dural repair done via Tachocomb (R). Copyright (C) 2010 S. Karger AG, Base
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