Anatomy of the human spinal cord arachnoid cisterns: applications for spinal cord surgery

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OBJECTIVE

The goal in this study was to describe the overall organization of the spinal arachnoid mater and spinal subarachnoid space (SSAS) as well as its relationship with surrounding structures, in order to highlight spinal cord arachnoid cisterns.

METHODS

Fifteen spinal cords were extracted from embalmed adult cadavers. The organization of the spinal cord arachnoid and SSAS was described via macroscopic observations, optical microscopic views, and scanning electron microscope (SEM) studies. Gelatin injections were also performed to study separated dorsal subarachnoid compartments.

RESULTS

Compartmentalization of SSAS was studied on 3 levels of axial sections. On an axial section passing through the tips of the denticulate ligament anchored to the dura, 3 subarachnoid cisterns were observed: 2 dorsolateral and 1 ventral. On an axial section passing through dural exit/entrance of rootlets, 5 subarachnoid cisterns were observed: 2 dorsolateral, 2 lateral formed by dorsal and ventral rootlets, and 1 ventral. On an axial section passing between the two previous ones, only 1 subarachnoid cistern was observed around the spinal cord. This compartmentalization resulted in the anatomical description of 3 elements: the median dorsal septum, the arachnoid anchorage to the tip of the denticulate ligament, and the arachnoid anchorage to the dural exit/entrance of rootlets. The median dorsal septum already separated dorsal left and right subarachnoid spaces and was described from C1 level to 3 cm above the conus medullaris. This septum was anchored to the dorsal septal vein. No discontinuation was observed in the median dorsal arachnoid septum. At the entrance point of dorsal rootlets in the spinal cord, arachnoid trabeculations were described. Using the SEM, numerous arachnoid adhesions between the ventral surface of the dorsal rootlets and the pia mater over the spinal cord were observed. At the ventral part of the SSAS, no septum was found, but some arachnoid trabeculations between the arachnoid and the pia mater were present and more frequent than in the dorsal part. Laterally, arachnoid was firmly anchored to the denticulate ligaments’ fixation at dural points, and dural exit/entrance of rootlets made a fibrous ring of arachnoidodural adhesions. At the level of the cauda equina, the arachnoid mater surrounded all rootlets together—as a sac and not individually.

CONCLUSIONS

Arachnoid cisterns are organized on each side of a median dorsal septum and compartmentalized in relation with the attachments of denticulate ligament and exit/entrance of rootlets.

ABBREVIATIONS AVM = arteriovenous malformation; DREZ = dorsal root entry zone; SEM = scanning electron microscope; SSAS = spinal subarachnoid space.

Article Information

Correspondence Corentin Dauleac: Neurochirurgie A, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer 59, Bd Pinel, 69003, Lyon, France. corentin.dauleac@chu-lyon.fr.

INCLUDE WHEN CITING Published online July 12, 2019; DOI: 10.3171/2019.4.SPINE19404.

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

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Flowchart of the distribution of the specimens used in the study.

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    Median dorsal arachnoid septum. a: Spinal cord cervical section, superior view. The dorsal arachnoid leaflet (A) was raised, allowing examination of the median dorsal arachnoid septum (S) that separated right and left posterior subarachnoid spaces. Dorsal arachnoid leaflet covered the emergence of rootlets (R). Of note, arachnoid trabeculations (T) are present between dorsal rootlets and spinal cord. b: Dorsal view of the cervical spinal cord. By raising the dorsal arachnoid leaflet, the median dorsal arachnoid septum is observed. Some arachnoidal trabeculations from the median dorsal septum are present over the median dorsal vein (V). c: Left dorsolateral view of the cervical spinal cord. The left dorsal arachnoid leaflet was cut transversely and reclined medially. The median dorsal arachnoid septum is thick and firmly attached to the median dorsal vein. DM = dura mater. Figure is available in color online only.

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    Denticulate ligament and exit/entrance rootlets’ arachnoid attachment. a: Ventral view of the thoracic spinal cord. The arachnoid mater (A) covers the entire ventral surface of the spinal cord. Laterally, the arachnoid covers the ventral rootlets from the ventrolateral sulcus to their union with the dorsal rootlets at the level of their dural exit. b: Ventral view of the thoracic spinal cord. After disinsertion of the arachnoid (A) from its attachment on the dura mater (DM) around the exit of the rootlets, by raising the ventral arachnoid leaflet, rootlets (R) and denticulate ligament (DL) are observed. The dorsal and ventral arachnoid leaflets and the denticulate ligament are all anchored together on the same point of the dura mater (arrow). c: Left ventrolateral view of the thoracic spinal cord. Visualization of rootlets’ dural entrance/exit point: ventral and dorsal arachnoid leaflets met at this rootlets’ dural point as a fibrous ring around the rootlets (arrow). Figure is available in color online only.

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    Slice of the spinal cord, SEM view. a: Hemicervical spinal cord. Dura mater (DM) covered the arachnoid mater (A), which covered the spinal cord (SC) and rootlets (R). b: Enlargement of panel a. Dorsal arachnoid leaflet covered dorsal rootlets and appeared thicker just at the ventrolateral part of the rootlets. c: Upper dorsal right part of the thoracic spinal cord. Dura mater covered the arachnoid mater, which covered the spinal cord and rootlets. Arachnoid trabeculations (T) were present between rootlets and pia mater. d: Upper dorsal left part of thoracic spinal cord. Arachnoid trabeculations formed an arachnoid network connecting rootlets, pia mater, and dorsal arachnoid leaflet.

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    Gelatin injection in the dorsal subarachnoid space. Green gelatin was injected on the left side and red gelatin on the right side. The two colors did not mix between the sides, and were separated by the median dorsal arachnoid septum attached at the mid-dorsal vein. Figure is available in color online only.

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    3D didactic representation of the spinal cord. A: Section passing through the rootlets. Five subarachnoid cisterns were observed: 2 dorsolateral between the median dorsal septum medially and dorsal rootlets ventrally; 2 lateral between dorsal and ventral rootlets; and 1 ventral. B: Section passing between the dural fixation of denticulate ligaments and rootlets: 1 cistern was observed around the spinal cord, on each side of the median dorsal septum. C: Section passing through the dural fixation of denticulate ligaments. Three subarachnoid cisterns were observed: 2 dorsolateral between the median dorsal septum medially, denticulate ligament ventrolaterally, and dorsal arachnoid leaflet dorsally; and 1 ventral between ventral arachnoid leaflet and spinal cord. Copyright Corentin Dauleac. Published with permission. Figure is available in color online only.

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