Microanatomy of the dura mater at the craniovertebral junction and spinal region for safe and effective surgical treatment

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  • 1 Department of Neurosurgery and Division of Neuropathology, and
  • 2 Division of Neuropathology, Department of Brain Disease Research, Shinshu University School of Medicine, Matsumoto; and
  • 3 Department of Neurosurgery, Ina Central Hospital, Ina, Japan
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OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

ABBREVIATIONS CM = Chiari malformation; CM-I = CM type I; CVJ = craniovertebral junction; FMD = foramen magnum decompression.

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Contributor Notes

Correspondence Kiyoshi Ito: Shinshu University School of Medicine, Matsumoto, Japan. kitoh@shinshu-u.ac.jp.

INCLUDE WHEN CITING Published online March 20, 2020; DOI: 10.3171/2020.1.SPINE191424.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Do HM, Jensen ME, Cloft HJ, Dural arteriovenous fistula of the cervical spine presenting with subarachnoid hemorrhage. AJNR Am J Neuroradiol. 1999;20(2):348350.

    • Search Google Scholar
    • Export Citation
  • 2

    Hida K, Yamaguchi S, Seki T, Nonsuture dural repair using polyglycolic acid mesh and fibrin glue: clinical application to spinal surgery. Surg Neurol. 2006;65(2):136143.

    • Search Google Scholar
    • Export Citation
  • 3

    Kumar A, Bhattacharjee S, Sahu BP. Importance of C1 laminectomy in foramen magnum decompression surgery: a technical note. Asian J Neurosurg. 2014;9(4):235.

    • Search Google Scholar
    • Export Citation
  • 4

    Hong JT, Lee SW, Son BC, Analysis of anatomical variations of bone and vascular structures around the posterior atlantal arch using three-dimensional computed tomography angiography. J Neurosurg Spine. 2008;8(3):230236.

    • Search Google Scholar
    • Export Citation
  • 5

    Ito K, Aoyama T, Horiuchi T, Hongo K. Utility of nonpenetrating titanium clips for dural closure during spinal surgery to prevent postoperative cerebrospinal fluid leakage. J Neurosurg Spine. 2015;23(6):812819.

    • Search Google Scholar
    • Export Citation
  • 6

    Ito K, Aoyama T, Nakamura T, Novel dural incision and closure procedure for preventing postoperative cerebrospinal fluid leakage during the surgical removal of dumbbell-shaped spinal tumors: technical note. J Neurosurg Spine. 2016;25(5):620625.

    • Search Google Scholar
    • Export Citation
  • 7

    Nagata K, Kawamoto S, Sashida J, Mesh-and-glue technique to prevent leakage of cerebrospinal fluid after implantation of expanded polytetrafluoroethylene dura substitute—technical note. Neurol Med Chir (Tokyo). 1999;39(4):316319.

    • Search Google Scholar
    • Export Citation
  • 8

    Del Gaudio N, Vaz G, Duprez T, Raftopoulos C. Comparison of dural peeling versus duraplasty for surgical treatment of Chiari type I malformation: results and complications in a monocentric patients’ cohort. World Neurosurg. 2018;117:e595e602.

    • Search Google Scholar
    • Export Citation
  • 9

    Isu T, Sasaki H, Takamura H, Kobayashi N. Foramen magnum decompression with removal of the outer layer of the dura as treatment for syringomyelia occurring with Chiari I malformation. Neurosurgery. 1993;33(5):845850.

    • Search Google Scholar
    • Export Citation
  • 10

    Ito K, Yamada M, Horiuchi T, Hongo K. Appropriate surgical procedures for Chiari type 1 malformation and associated syrinx based on radiological characteristics of the craniovertebral junction [published online January 25, 2019]. Neurosurg Rev. doi:10.1007/s10143-019-01079-3

    • Search Google Scholar
    • Export Citation
  • 11

    Aoyama T, Yasuda M, Yamahata H, Radiographic measurements of C-2 in patients with atlas assimilation. J Neurosurg Spine. 2014;21(5):732735.

    • Search Google Scholar
    • Export Citation
  • 12

    Arslan D, Ozer MA, Govsa F, Kıtıs O. The ponticulus posticus as risk factor for screw insertion into the first cervical lateral mass. World Neurosurg. 2018;113:e579e585.

    • Search Google Scholar
    • Export Citation
  • 13

    Yuan XY, Yu SB, Li YF, Patterns of attachment of the myodural bridge by the rectus capitis posterior minor muscle. Anat Sci Int. 2016;91(2):175179.

    • Search Google Scholar
    • Export Citation
  • 14

    Protasoni M, Sangiorgi S, Cividini A, The collagenic architecture of human dura mater. J Neurosurg. 2011;114(6):17231730.

  • 15

    Yano S, Hida K. Indication of foramen magnum decompression with outer layer excision of dura mater for Chiari I malformation. Paper presented at: 33rd Annual Meeting of the Neurospinal Society of Japan; July 14, 2018; Nara, Japan.

    • Export Citation
  • 16

    Mizutani K, Miwa T, Akiyama T, Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus. Neuroradiology. 2018;60(3):325333.

    • Search Google Scholar
    • Export Citation
  • 17

    Enix DE, Scali F, Pontell ME. The cervical myodural bridge, a review of literature and clinical implications. J Can Chiropr Assoc. 2014;58(2):184192.

    • Search Google Scholar
    • Export Citation
  • 18

    Hack GD, Hallgren RC. Chronic headache relief after section of suboccipital muscle dural connections: a case report. Headache. 2004;44(1):8489.

    • Search Google Scholar
    • Export Citation
  • 19

    Hack GD, Koritzer RT, Robinson WL, Anatomic relation between the rectus capitis posterior minor muscle and the dura mater. Spine (Phila Pa 1976). 1995;20(23):24842486.

    • Search Google Scholar
    • Export Citation
  • 20

    Kai Y, Hamada J, Morioka M, Arteriovenous fistulas at the cervicomedullary junction presenting with subarachnoid hemorrhage: six case reports with special reference to the angiographic pattern of venous drainage. AJNR Am J Neuroradiol. 2005;26(8):19491954.

    • Search Google Scholar
    • Export Citation

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