Innervation of spinal dura mater and dura mater of the posterior cranial fossa.
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Cranial Fossa, Posterior↗
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[Study of some morphologic aspects of the human dura mater].
Dura mater of 100 Chinese adult cadavers were studied. The average total surface area of the dura mater was 0.080 m2 in male and 0.076 m2 in female. The thickness was 0.25-0.40 mm, and the tensile stress was around 37 kg/mm2. The architecture of the fibers in dura mater were chiefly in arcuate or radiated form, some running longitudinally or in oblique direction. Frozen human dura mater has been widely utilized in surgery, obstetrics, gynecology, ophthalmology, ENT and oral surgery, etc.
Anthropometry↗
Examination of the safety and efficacy of an absorbable dura mater substitute (Dura Patch) in normal applications in neurosurgery.
BACKGROUND: The possibility of the transmission of Creutzfeldt-Jakob disease and slow virus infection (HIV) by cadaveric dura implants makes it necessary to find synthetic, absorbable substitute materials for plastic reconstruction of the dura mater. Dura-Patch is a bilayered composite of a dyed polydioxanone (PDS) foil and an undyed fleece of Polyglactin 910 (Vicryl) and PDS threads, known to be completely resorbable. METHODS: The Dura-Patch was tested prospectively in 101 patients undergoing 75 supratentorial, 20 infratentorial, and 6 spinal operations in seven different neurosurgical departments. Fixation of the substitute was either by suturing, gluing, or both. The specific tissue properties were investigated considering biocompatibility, form, size, adaptability, fixation, scarring, and resistance to CSF tearing with the aid of hematologic and neurological parameters, CCT, and/or MRI scanning up to 6 months postoperatively. RESULTS: A total of 76 of 101 patients completed the study (75%). The biocompatibility of the Dura-Patch with timely absorption of the implant material was excellent without exception. There was no notable local scarring and no infections. Transient CSF cushioning in 12.9% of the patients was in keeping with the normal range. The elasticity and flexibility of the Dura-Patch was rated as "good" in 90% and was still better when the size of the implant increased, with an overall rating of handling as "good" or "excellent" in 97% of all operations. CONCLUSIONS: The new absorbable Dura-Patch showed itself to be suitable for both plastic dura reconstruction and plastic extension of the subdural space with primary, watertight, germproof closure in routine intracranial and spinal tumor removal.
Brain Diseases↗
Ultrastructure of the human spinal arachnoid mater and dura mater.
Human spinal dura and arachnoid, obtained during neurosurgical operations, were studied by transmission electron microscopy. The ultrastructure of spinal meninges largely conformed to the morphology of the cranial meninges, but some minor differences were detected. The dura was composed of an outermost loosely arranged fibroelastic layer, a middle basically fibrous portion and an innermost cellular layer (dural border cell layer). The dural border cell layer was characterised by multiple interdigitating cell processes, no extracellular collagen, significant extracellular spaces and few cell junctions. Paravascular vesiculated nerve profiles were encountered within the fibroadipose epidural tissue. The arachnoid was composed of an outermost portion (arachnoid barrier cell layer), presenting tightly packed cells, numerous tight junctions and no extracellular collagen. In view of its numerous tight junctions, the arachnoid barrier cell layer is considered to represent an effective morphological and physiological meningeal barrier between the cerebrospinal fluid in the subarachnoid space and the blood circulation in the dura. The arachnoid barrier layer was always characterised by a distinct continuous basal lamina on its inner surface towards the innermost collagenous portion of the arachnoid (arachnoid reticular cell layer). The interweaving arachnoid trabecular cells within this layer possessed numerous mitochondria and were anchored to the inner surface of the arachnoid barrier cell layer by desmosomes. An additional layer of flattened branching cells was demonstrated along the inner surface of the arachnoid reticular cell layer and assumed to be an "arachnoid border cell layer'. Morphological data suggest that the dura and arachnoid closely adhere at spinal levels in man without any naturally occurring "subdural space'. However, structurally, the dural border cell layer forms a weak cell layer at the dura-arachnoid continuum that is easily disrupted. The creation of an artifactual subdural space at spinal levels is discussed.
Adolescent↗
Mitral valve replacement with dura mater bioprostheses.
Dura mater bioprostheses for cardiac valve replacement were first introduced in Brazil. They have been used since 1975 at the National Heart Hospital, London, as a mitral valve replacement instead of fascia lata valves or inverted aortic homograft valves. During this period 120 patients have had dura mater valves inserted in the mitral position; 29 also received an aortic valve replacement, 6 with dura mater, 20 with an aortic homograft, 2 with an aortic xenograft and 1 with a prosthetic valve. Perivalvular leaks occurred with seven of these mitral valves, and another seven presented with detached cusps. All but one of these 14 valves were replaced. Emboli have occurred in four of the patients, one of whom died after 35 months with thrombus on the aortic valve, but with an unaffected mitral valve. There were 15 early deaths, a hospital mortality of 12.5%, and 10 late deaths, a postoperative mortality of 9.5%. Actuarial analysis has shown a four-year postoperative survival of 78.9%.
Aortic Valve↗
Nitric oxide synthase immunoreactivity in the rat dura mater.
The dura mater has been implicated as a tissue where vascular headache develops. Identification of the neural components of this tissue is a prerequisite for understanding the mechanisms of this pathological process. The nitric oxide molecule, a potent vasodilator, may contribute to the vascular headache process by dilating dural vasculature. Our immunohistochemical study using nitric oxide synthase (NOS) antibodies revealed NOS-positive nerve fibers and a prominent mast cell population in the rat dura. A majority of the immunopositive fibers were associated with the anterior meningeal artery and its branches and sparse innervation with the middle meningeal artery, its branches, and superior sagittal sinus. We propose that the NOS-positive nerve fibers and mast cells be considered as possible participants in the pathogenesis of vascular headache.
Amino Acid Oxidoreductases↗
[MR imaging of postoperative change of dura mater of rabbits--effect of contrast enhancement of dura mater & correlation with pathological findings].
To explain the mechanism of benign postoperative dural enhancement, the author made experimental model of rabbit's subdural hematoma and performed magnetic resonance (MR) imaging with gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA). On plain T1-weighted images, infused blood or red blood cells could not be detected immediately after surgery. On follow up plain T1-weighted images, the infused blood could be identified in only a case with 1 cc blood infusion. Marked dural enhancement could be seen immediately after surgery and continued three to fourteen days after 1 cc or 0.1 cc blood or 0.1 cc red blood cells infusion. To the contrary, no definite dural enhancement could be seen in the cases with plasma or saline infusion. Subdural red blood cells were required for dural enhancement immediately after surgery. Pathological findings revealed three types of reaction to infused blood: newly formed capillarization with fresh hemorrhage from the capillaries; subdural hematoma and no reaction. After vanishment of dural enhancement, pathological findings of the specimens were identical to that of normal dura. Dural enhancement may be induced by increased permeability of the dura associated with subdural hematoma and/or the extravasation of the contrast from newly formed capillaries.
Animals↗
[Evaluation of heterologous dura mater as a dura substitute: experimental study in dogs].
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Animals↗
[The solvent-dried dura mater. A new dura transplant in the animal experiment].
After the excision of 7 X 5 mm abdominal muscle sections in an experiment using rats, rehydrated, solvent dried dura grafts of the same size were implanted. After three hours the tissue reaction of the transplant areas were continuously examined under a light and electron microscope for 14 months. A gradual graft decomposition advancing in a coating form from the periphery to the center and a simultaneous replacement with collagenous connective tissue of the body resulted due to an absorbent granulation tissue rich in cells and blood vessels after the initial infiltration of neutrophil granular leukocytes caused by the operation. A fibrous-rich connective tissue plate, in part forming two layers and thereby serving as a reminder of the former dura graft is decomposed in the abdominal muscles of the rats without infection or rejection and replaced with endogenous connective tissue. The duration of this decomposition and transformation process is contingent on the size of the graft and the tissue reactivity in the surrounding transplant area.
Animals↗
Results of replacement of cardiac valves by homologous dura mater valves.
Homologous dura mater valve was employed in a series of 533 patients in the period between January 1971 and May 1974. The dura mater was sterilized and preserved in 98 percent glycerol solution at room temperature. Important data were the following (1) no significant pressure gradient through the vale at rest; (2) no bacterial endocarditis; (3) two cases of fungal endocarditis; (4) no degeneration or retraction of the leaflets; (5) no thrombus formation in the valve; and (6) no anticoagulants were used in this series.
Aspergillosis↗
Reconstructive techniques in gynecologic oncology: the use of human dura mater allografts.
Human dura mater has been utilized in various reconstructive procedures following radical pelvic surgery at the Division of Gynecologic Oncology, University of Miami School of Medicine. Our preliminary results indicate that this allograft is strong, durable, and acts as a good biological barrier. However, it does not seem to prevent the development of enteropelvic fistulae in patients who undergo total pelvic exenteration following radiotherapy. Dura mater has also been employed in abdominal hernia repairs, repair of wound dehiscenses, and in the coverage of the femoral vessels after groin dissection. Provisional results with these reconstructive techniques appear promising. These results are discussed, and suggestions regarding the use of this allograft are delineated.
Carcinoma, Squamous Cell↗
Biocompatibility evaluation of dura mater substitutes in an animal model.
Dura-Guard Dural Repair Patch, PRECLUDE Dura Substitute, and Codman ETHISORB Dura Patch were evaluated in a six-month dural tissue reaction study in rabbits. Bilateral craniotomy was followed by subdural implantation for each dura mater substitute. The surgical procedure for the sham control group was the same except that no material was implanted. Implantation of all of these dura mater substitutes for 28, 91, or 182 days post-implantation did not result in any deaths or clinical neurobehavioral abnormalities, changes in cerebrospinal fluid, or significant macroscopic changes at necropsy. However, histomorphologic evaluation of the implantation sites revealed some differences in the tissue response to these materials. For Dura-Guard Dural Repair Patch, a nonabsorbable material derived from bovine pericardium, the implantation site was characterized by fibrosis of the overlying area with islands of osseous metaplasia and adhesions to the brain surface. Over time, infiltrative fibrosis of the implant resulted in separation of the collagenous layers of the implant and compression of the underlying brain. Fibrosis of the overlying area that incorporated this material formed a 'replacement' dura mater. Adhesions to the brain surface observed initially were still present at six months post-implantation. Implantation of PRECLUDE Dura Substitute, a nonabsorbable material comprised of expanded polytetrafluoroethylene, resulted in virtually no early reaction, and few adhesions to the brain surface at any time period. Although this material was eventually incorporated by fibrosis, islands of osseous metaplasia were also observed in this 'replacement' dura mater. The tissue reaction to Codman ETHISORB Dura Patch, an absorbable material comprised of polyglactin 910 and polydioxanone, was generally characterized by low-grade granulomatous inflammation and initial adhesions to the brain surface. The three-dimensional structure of this implant acted as a scaffold to guide the development and integration of a 'replacement' dura mater. The absorption of the material was associated with complete resolution of the inflammatory reaction, a lack of cerebral adhesions, and restoration of the normal architecture of this region. In conclusion, subdural implantation of Dura-Guard Dural Repair Patch, PRECLUDE Dura Substitute, or Codman ETHISORB Dura Patch in rabbits for up to six months resulted in the eventual restoration of the dura mater without significant adverse effects. However, osseous metaplasia associated with nonabsorbable Dura-Guard Dural Repair Patch and PRECLUDE Dura Substitute, and the infiltration of Dura-Guard Dural Repair Patch by fibrosis suggests that long-term follow-up may be needed after the use of these materials in patients. An advantage of Codman ETHISORB Dura Patch was that it was completely absorbed after guiding the restoration of the dura mater without any morphological sequelae.
Absorbable Implants↗
Nerve fibres and their terminals of the dura mater encephali of the rat.
The dura mater encephali of the rat is richly supplied by myelinated (A-axons) and unmyelinated (C-axons) nerve fibres. For the supratentorial part the main nerve supply stems from all three branches of the trigeminal nerve. Finally, 250 myelinated and 800 unmyelinated nerve fibres innervate one side of the supratentorial part. The vascular bed of the dura mater exhibits long postcapillary venules up to 200 micron in length with segments of endothelial fenestration. Lymphatic vessels occur within the dura mater. They leave the cranial cavity through the openings of the cribriform plate, rostral to the bulla tympani together with the transverse sinus, and the middle meningeal artery. The perineural sheath builds up a tube-like net containing the A- and C-axons. It is spacious in the parietal dura mater and dense at the sagittal sinus along its extension from rostral to caudal and at the confluence of sinuses. Terminals of both the A- and C-axons are of the unencapsulated type. Unencapsulated Ruffini-like receptors stemming from A-axons are found in the dural connective tissue at sites where superficial cerebral veins enter the sagittal sinus and at the confluence of sinuses. The terminations of single A-axons together with C-fibre bundles mix up in their final course in one Schwann cell to build up multiaxonal units or terminations (up to 15 axonal profiles). A morphological differentiation is made due to the topography of these terminations; firstly, in different segments of the vascular bed: postcapillary venule, venule, the sinus wall, lymphatic vessel wall, and secondly, within the dura mater: inner periosteal layer, collagenous fibre bundles of the meningeal layer and at the mesothelial cell layer of the subdural space.
Animals↗
The use of glycerol-preserved homologous dura mater grafts in cardiac surgery: the Southampton experience.
Dura mater obtained from human cadavers and preserved in glycerol was used as patch grafts in various positions in the repair of acquired and congenital cardiac defects in 107 patients over a four-year period. The ages of the recipients ranged from 2 days to 75 years. The mean duration of preservation of the dura mater before use was 25.2 +/- 8.1 weeks. The dural grafts were used as an aortic root gusset in 38 patients (35.5%) undergoing aortic valve replacement, for enlargement of the pulmonary artery or right ventricular outflow tract or both in 38 patients (35.5%), and for repair of coarctation of the aorta in 10 patients (9.4%). The grafts also were used for closure of atrial septal defects, for a variety of other congenital cardiac anomalies, and for replacement of segments of the aorta (2 patients). There were no complications attributable to the use of dura mater. Dura mater preserved in glycerol would seem to be a suitable material for repair of various cardiac defects because of its strength, low antigenicity, athrombogenicity, ease of handling, availability in large sizes, and rapid bonding to host tissue. However, long-term follow-up is important to assess the lasting properties of dura mater.
Adolescent↗
[Observations concerning the vascularization of the dura mater cerebri. II. Vascularized dura villi at the entrance into the Canalis opticus (author's transl)].
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Aged↗
Clinical experience with expanded polytetrafluoroethylene sheet used as an artificial dura mater.
Dural repair using chemically treated cadaveric dura mater often results in atrophic and fragile change of the substitute as well as adhesion between the dura mater and brain surface at reoperation. Creutz-feldt-Jakob disease has occurred after repair using cadaveric dura mater. Expanded polytetrafluoroethylene (EPTFE) surgical sheet was used for dural repair in 34 patients. Suturing of EPTFE was easy and the incidence of cerebrospinal fluid accumulation in the epidural space was the same as when cadaveric dura mater was used. Six patients underwent reoperation, 1-15 months after the first operation. At reoperation the EPTFE sheet showed no change except for becoming transparent, and the strength was well preserved. A very thin layer of granulation tissue was formed between the EPTFE sheet and brain surface, but the EPTFE sheet was easily detached from the brain surface without adhesion even 15 months after the first operation. Our results suggest that the EPTFE sheet can be used safely and effectively as an artificial dura mater.
Brain Diseases↗
Dura mater for soft-tissue augmentation. Evaluation in a rabbit model.
Irradiated human dura mater, a commercially available preparation of dura mater (Tutoplast), and irradiated rabbit dura mater were implanted in subcutaneous pockets in the pinna and forehead of New Zealand white rabbits and evaluated for their usefulness in soft-tissue augmentation at 3 months and 6 months. Postoperatively, no evidence of erythema, purulence, hematoma or seroma formation, wound dehiscence, graft extrusion, or flap necrosis was noted. Irradiated human dura mater was well tolerated by the host and elicited a mild cellular inflammatory response. The graft was well preserved, infiltrated by fibrous connective tissue, and fixed in place in the pinna sites. Forehead grafts were surrounded by a capsule of host tissue and were intact. Dura mater seems to be useful for soft-tissue augmentation. Tutoplast may give good results clinically. Because this represents a short-term evaluation, long-term clinical results are needed to define the potential of dura mater grafts.
Animals↗
Direct innervation of sensory fibers from the dorsal root ganglion of the cervical dura mater of rats.
STUDY DESIGN: Sensory innervation in the cervical dura mater of rats was investigated immunohistochemically in whole tissues and transverse sections of the decalcified vertebral column. OBJECTIVE: To investigate the origin and distribution of sensory innervation in the cervical dura mater. SUMMARY OF BACKGROUND DATA: It has been generally accepted that irritation of the cervical structures is one of the major causes of pain in the neck and the upper extremities. Sensory fibers in the cervical dura mater are possible mediators of pain. However, there is little information about sensory innervation in the cervical dura mater, including the epiradicular sheath. METHODS: Ten Wistar rats were used for wholemount immunohistochemical observations of the cervical dura mater. The vertebral columns of five rats were processed for immunohistochemistry after decalcification. In all specimens, sensory fibers were demonstrated by the peptide immunohistochemistry, and sensory innervation was examined. RESULTS: The cervical dura mater was arbitrarily divided into three areas: ventral, dorsal, dorsal root ganglion. A large number of fibers were in the dorsal root ganglion area and were distributed in the corresponding segments. Some calcitonin gene-related peptide immunoreactive fibers in the dorsal root ganglion were directly innervated from dorsal root ganglion area neurons and did not form nerve bundles, similar to the sinuvertebral nerve. Several immunoreactive fibers were seen in the ventral area; fibers were rarely observed in the dorsal area. CONCLUSIONS: A large number of sensory fibers are segmentally distributed in the cervical dura mater, and some of them are directly traced from dorsal root ganglion neurons.
Animals↗