PubMed · 5467725
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W Pauly. 1970-05-01. [Subdural empyema].. https://pubmed.ncbi.nlm.nih.gov/5467725/
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AIMS: To describe the anatomy and the arrangement of the arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve and to consider their possible clinical relevance for cerebrospinal fluid dynamics and fluid pressure in the subarachnoid space of the human optic nerve. METHODS: Postmortem study with a total of 12 optic nerves harvested from nine subjects without ocular disease. All optic nerves used in this study were obtained no later than 7 hours after death, following qualified consent for necropsy. The study was performed with transmission (TEM) and scanning electron microscopy (SEM). RESULTS: The subarachnoid space of the human optic nerve contains a variety of trabeculae, septa, and stout pillars that are arranged between the arachnoid and the pia layers of the meninges of the nerve. They display a considerable numeric and structural variability depending on their location within the different portions of the optic nerve. In the bulbar segment (ampulla), adjacent to the globe, a dense and highly ramified meshwork of delicate trabeculae is arranged in a reticular fashion. Between the arachnoid trabeculae, interconnecting velum-like processes are observed. In the mid-orbital segment of the orbital portion, the subarachnoid space is subdivided, and can appear even loosely chambered by broad trabeculae and velum-like septa at some locations. In the intracanalicular segment additionally, few stout pillars and single round trabeculae are observed. CONCLUSION: The subarachnoid space of the human optic nerve is not a homogeneous and anatomically empty chamber filled with cerebrospinal fluid, but it contains a complex system of arachnoid trabeculae and septa that divide the subarachnoid space. The trabeculae, septa, and pillars, as well as their arrangement described in this study, may have a role in the cerebrospinal fluid dynamics between the subarachnoid space of the optic nerve and the chiasmal cistern and may contribute to the understanding of the pathophysiology of asymmetric and unilateral papilloedema. All the structures described are of such delicate character that they can not even be visualised with high resolution magnetic resonance imaging (MRI).
We reported a case of bleeding from the varix of a transverse-sigmoid sinus dural arteriovenous fistula with pure leptomeningeal drainage. A 55-year-old man presented with visual disturbance. neurological examination revealed left homonymous hemianopsia. CT scans demonstrated a subcortical hemorrhage in the right occipital lobe. Right external carotid angiograms showed a dural arteriovenous fistula of the transverse-sigmoid sinus fed by middle meningeal arteries and the occipital artery. The draining vein was the cortical vein with a varix. Transverse and sigmoid sinuses were patent. We concluded that the cause of the subcortical hemorrhage was a varix of the dural arteriovenous fistula. Initially, we embolized the dural arteriovenous fistula using a transarterial approach with GDC. Additionally, we interrupted the draining vein of the dural arteriovenous malformation. Angiographic cure was obtained and the postoperative course was uneventful. We discussed the clinical features, and the management of this case.
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