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Kiyoshi Ito, Mitsunori Yamada, Tetsuyoshi Horiuchi, and Kazuhiro Hongo


Few reports have been published regarding the detailed microsurgical anatomy of the dura mater at the craniovertebral junction (CVJ), although many neurosurgeons have had the opportunity to conduct surgeries in this region, such as in cases of Chiari malformation. The authors aimed to evaluate the detailed and precise microsurgical anatomy of the dura mater at the CVJ for safe and effective surgical treatment at this area.


This study consisted of dissection of 4 formalin-fixed, continuous, human cadaveric dura maters, extending from the posterior fossa to the C2 level. After removing the occipital bone and C1 laminae, a dural incision was made to harvest the specimen. The following structural and topographical aspects of the dura mater in each region were studied: 1) thickness, 2) morphological characteristics, and 3) vascular structures.


The average thicknesses of the dura mater were 313.4 ± 137.0 μm, 3051.5 ± 798.8 μm, and 866.5 ± 359.0 μm in the posterior cranial fossa, CVJ, and spinal region, respectively. The outer layer of the posterior cranial dura mater and the tendon of the rectus capitis posterior minor muscle were connected, forming the “myodural bridge.” The dura mater at the CVJ had a well-developed vascular network. These vascular structures were determined to be veins or the venous sinus, and were mainly located around the interface between the inner layer of the cranial dura mater and the rectus capitis posterior minor muscle layer. Regarding the morphological features, the bulging located in the inner layer of the dura mater at the CVJ was determined to be the marginal sinus, and contained a pacchionian granulation that allowed for CSF circulation. In the spinal region, the dura mater was characterized by a single, thick layer enclosing the collagen fibers with almost the same orientation.


The dura mater at the CVJ displayed dynamic morphological changes within an extremely short segment. Its characteristic anatomical features were not similar to those in the cranial regions. The dural bulging at the CVJ was determined to be the venous sinus. During surgery in the posterior fossa, CVJ, and spinal cord, different procedures should be used because of the specific microsurgical anatomy of each region.

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Shin-Ichi Miyatake, Shinji Kawabata, Yoshinaga Kajimoto, Atsushi Aoki, Kunio Yokoyama, Makoto Yamada, Toshihiko Kuroiwa, Motomu Tsuji, Yoshio Imahori, Mitsunori Kirihata, Yoshinori Sakurai, Shin-Ichiro Masunaga, Kenji Nagata, Akira Maruhashi, and Koji Ono

Object. To improve the effectiveness of boron neutron capture therapy (BNCT) for malignant gliomas, the authors used epithermal rather than thermal neutrons for deep penetration and two boron compounds—sodium borocaptate (BSH) and boronophenylalanine (BPA)—with different accumulation mechanisms to increase the boron level in tumors while compensating for each other's faults.

Methods. Thirteen patients, 10 of whom harbored a glioblastoma multiforme (GBM), one a gliosarcoma, one an anaplastic astrocytoma, and one an anaplastic oligoastrocytoma, were treated using this modified BNCT between January 2002 and December 2003. Postoperatively, neuroimaging revealed that only one patient with a GBM had no lesion enhancement postoperatively. The patients underwent 18F-BPA positron emission tomography, if available, to assess the accumulation and distribution of BPA before neutron radiotherapy. The neutron fluence rate was estimated using the Simulation Environments for Radiotherapy Applications dose-planning system before irradiation. The patients' volume assessments were performed using magnetic resonance (MR) imaging or computerized tomography (CT) scanning. Improvements in the disease as seen on neuroimages were assessed between 2 and 7 days after irradiation to determine the initial effects of BNCT; its maximal effects were also analyzed on serial neuroimages.

The mean tumor volume before BNCT was 42.3 cm3. Regardless of the pre-BNCT tumor volume, in every patient harboring an assessable lesion, improvements on MR or CT images were recognized both at the initial assessment (range of volume reduction rate 17.4–71%, mean rate 46.4%) and at follow-up assessments (range of volume reduction rates 30.3–87.6%, mean rate 58.5%). More than 50% of the contrast-enhanced lesions disappeared in eight of the 12 patients during the follow-up period.

Conclusions. This modified BNCT produced a good improvement in malignant gliomas, as seen on neuroimages.