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You are watching: Follows irregular contours of spinal cord surface

StatPearls . Treasure Island (FL): StatPearls Publishing; 2021 Jan-.


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Introduction

The brain and spinal cord space enveloped within three layers the membrane collectively known together the meninges, through the cranial meninges particularly referring to the section that covers the brain. From superficial to deep, the three layers are the dura, arachnoid, and pia—the hatchet “mater,” Latin for mother, often follows these surname (i.e., dura mater, arachnoid mater, pia mater).<1> The dura, Latin for “hard,” is created of thick connective tissue and adheres come the inner surface ar of the skull and vertebrae. The arachnoid is a thin wispy membrane the lies simply deep to the dura and also is superficial come the pia, the an extremely thin, clear membrane that straight adheres to the surface ar of the mind and spinal cord. Forming from this layers are three clinically far-ranging spaces, or potential spaces (sometimes dubbed cavities): the epidural, subdural, and also subarachnoid spaces, native superficial come deep. The chief function of the meninges is to safeguard the materials of the brain and spinal cord.<2>


Structure and also Function

Epidural Space

Between the roof that the skull (i.e., calvarium) and also the exceptional surface the the dura potentially lies the epidural space.  if arteries and veins run between the inner surface of the calvarium and the dura, the epidural room typically exists pathologically, since the superficial class of the dura, the periosteal layer, is securely attached to the periosteum the the skull.

Dura Mater

The outermost mater that the meninges, the dura, is created of 2 layers: the periosteal layer the lies closest to the calvarium and the meningeal layer that lies closest to the brain tissue. This together contribute to the dura gift a thick, dense, fibrous membrane that is quite inelastic. The periosteal layer consists of fibroblasts and osteoblasts, with a huge quantity that extracellular collagen existing in ~ its intercellular space, offering the dura that is strength.<1> These two layers are mainly fused, only separating to kind venous sinuses and dural reflections. Dural reflections refer to locations where 2 face-to-face meningeal great descend right into the cranial cavity to kind the septa the compartmentalize the brain. The two main dural reflections space the falx cerebri and also the tentorium cerebelli. The sickle-shaped falx cerebri is attached to the roof that the cranium and also suspends down into the interhemispheric fissure, separating the right and also left cerebral hemispheres. The “U” shaped tentorium cerebelli runs transversely in between the cerebellum and also occipital lobes. Importantly, over there is an opened in the falx cerebri, well-known as the tentorial incisura (sometimes described as the tentorial notch), that permits the midbrain to happen through into the center cranial fossa.

Subdural Space

The subdural space is the room that perhaps exists between the meningeal great of the dura and also the arachnoid mater. Comparable to the epidural space, the subdural an are typically exists only under pathological conditions.

Arachnoid Mater

The arachnoid sits between the dura and also the pia and also is an avascular membrane the is connected in cerebrospinal liquid (CSF) line via the subarachnoid space.<2> unlike the pia mater, the arachnoid does not follow the contours of the cortical sulci yet bridges them. When its figure varies in between locations in the cranium, it is normally a thin, lucent membrane. The structure is composed of a superficial mesothelial layer below the dura, a main layer written of cells conjoined by numerous junction proteins, and a deep class of much less tightly packed cells with plenty of collagen fibers within your intercellular space. Evidence suggests that the clusters of arachnoid villi (i.e., arachnoid granulations), or portions of the arachnoid the protrude right into the dura mater, serving as a network because that communication between the systemic venous system and the CSF.

Subarachnoid Space

The subarachnoid room is the cerebrospinal fluid-filled room that exists between the arachnoid and the pia. Within the lateral ventricles the the brain, the choroid plexus produces CSF, i m sorry passes into the subarachnoid space via the foramina the Luschka.<3><4> since the subarachnoid room is continuous between the mind and spinal cord, CSF flows v the foramen magnum under to the distal section of the spinal cord. The primary features of the CSF space to cushion the mind and spinal cord indigenous trauma and to it is provided them through nutrients and also remove waste. In enhancement to the CSF, the major arteries that the mind run through the subarachnoid space. Also, projecting into this space are arachnoid trabeculae which room strands that arachnoid mater connective tissue.

Pia Mater

The deepest great of the meninges, the pia mater, is created of 2 layers and, unlike the arachnoid, follows the border of the sulci and gyri. The outer layer of the pia, referred to as the epipial layer, has collagen fibers; the within layer, or the intima pia, contains elastic and also reticular fibers.<5><6> when mesothelial cells of the epipial layer connect to the arachnoid mater via the arachnoid trabeculae, the intima pia adheres to the outermost layer of neural tissue known as the glial membrane. Importantly, the cerebral pia mater develops sheaths roughly the blood vessels that enter and also exit the mind perpendicular come the meninges, especially from the subarachnoid space to within the brain parenchyma.<7> This sheathing creates an interstitial fluid-filled space, well-known as the perivascular or Virchow-Robin space, in between the courage walls and the pia.


Embryology

While the dura mater, sometimes dubbed the pachymeninx, is obtained from the mesoderm, the arachnoid and also pia mater, together referred to as the leptomeninges, are derived from the ectoderm. Specifically, the breakthrough of the meninges begins with what is well-known as the perimedullarly mesenchyme, which contains cells indigenous both the ectoderm and mesoderm.<1><8> The leptomeninges creates first, together cells from the neural crest differentiate into the pia and also arachnoid. Subsequently, dura differentiation wake up from sclerotomes, a subdivision the the mesodermal somites. The dura differentiates from the breakthrough of the skull together the venous sinuses begin to develop and arises indigenous two distinctive condensations of cells in the peripheral mesenchyme; the more thickness condensation forms the periosteal layer, if the thinner forms the meningeal layer.<9>


Blood Supply and Lymphatics

Epidural an are and Dura Mater

While it was once thought that the dura was avascular, the is actually extremely vascular in nature, together the significant vessels the supply it operation in the epidural room deep come the skull. The major arteries that supply the dura are acquired from the inner carotid, vertebral, maxillary, ascending pharyngeal, lacrimal, occipital, and also ethmoidal arteries. Of the arteries that supply the dura, the middle meningeal artery (MMA), which branches native the interior carotid artery’s maxillary branch, is the most important.<1> The MMA beginning the cranium via the foramen spinosum and also runs inside the epidural space, forming grooves against the skull. Importantly, when the MMA gives the dura, the middle cerebral artery that branches native the interior carotid artery it is provided the brain. Venous drainage of the dura occurs via the satellite veins that the meningeal arterial trunks and also the dural venous sinuses.

The dural venous sinuses space venous networks formed wherein the periosteal and meningeal class of the dura mater separate and also serve as the major pathway because that venous drainage native the brain. They include the superior sagittal sinus, worse sagittal sinus, straight sinus, and also sigmoid sinus, amongst others.<1> The dural sinuses mainly drain blood via the sigmoid sinuses into the interior jugular veins. In addition to receiving blood indigenous both the brain’s internal and also external veins, the dural sinuses receive CSF indigenous the subarachnoid space.

Subdural Space

The many notable blood vessels concerned the subdural an are are the bridging veins, i beg your pardon pass v the subdural space transversely top top their way to drainpipe the cerebral hemispheres right into the dural venous sinuses. The rupturing of this veins is the many common reason of subdural hematomas.

Arachnoid Mater and Subarachnoid Space

The arachnoid mater is avascular. Locations of the subarachnoid room where over there are large gaps are referred to as cisternae. The ambient cistern, which surrounds the midbrain, includes branches the the posterior cerebral and superior cerebellar arteries; it also contains the basal vein of Rosenthal. The superior cerebellar cistern consists of the petrosal vein and the superior cerebellar artery. Additionally, whereby the arachnoid mater bridges the cerebral hemispheres deep to the falx cerebri, the subarachnoid room houses the anterior cerebral arteries.

Pia Mater

The pia mater is very vascularized and also contains networks the capillaries the nourish the brain. Additionally, the parts of the pia mater that kind the perivascular an are eventually fuse through the blood ship they surround.

Meningeal Lymphatic Vessels

The lymphatic device of the meninges to be recently discovered in 2015 via the usage of electron microscopy, and work is continuous to much better understand the structure and also function.<10><11> Lymphatic vessels operation tangentially to the dural venous sinuses and also meningeal arteries and connect come the deep cervical lymph nodes. Additionally, these vessels have been shown to absorb CSF for drainage and are believed to pat a main role in connecting the immune and also nervous equipment through immune cell trafficking.


Nerves

The meninges primarily receives innervation by the vagus and trigeminal nerves, through some cervical spinal nerves contributing come a lesser degree.<2> when the dura that the anterior cranial fossa is primarily innervated through the anterior and also posterior ethmoidal nerve branches the the ophthalmic division of the trigeminal nerve, the dura of the center cranial fossa receive nerve supply from a branch of the maxillary division of the trigeminal nerve. The tentorium cerebelli and the posterior third of the falx cerebri are mostly innervated by the tentorial nerve, which is likewise a branch of the ophthalmic department of the trigeminal nerve. The very first three cervical spinal nerves, together with the cranial sorry trunk, mainly innervate the infratentorial dura the the posterior cranial fossa.


Surgical Considerations

Meningiomas space the many common kind of cranial neoplasms and also arise indigenous the cells that make up the arachnoid villi, known as arachnoid cap cells. They are generally benign but can existing in an atypical or malignant fashion.<12> While surgical procedure is typically employed come treat meningiomas, the hazard of significant neurological complications had actually led to its steady decline, especially when the tumor is in areas of the skull near the vital neurovascular structures.<13> The main strategy for cranial meningioma remove is full excision, which generally entails the remove of the dura, bone, and also vascular sinuses that have been infiltrated by the tumor. In current decades, endoscopic and minimally invasive keyhole philosophies to surgery have actually seen heightened implementation in pick cases. Ultimately, the surgical strategy is patient-tailored and depends on every tumor’s location and characteristics.


Clinical Significance

The meninges theatre a function in many pathological conditions. Bacter meningitis (BM) is a condition where one gets inflammation that the meninges as result of bacteria invading the subarachnoid space, most frequently by the pathogens Streptococcus pneumoniae and Neisseria meningitides.<14> bacterial meningitis may bring about neuronal damages as a an outcome of boosts in intracranial pressure and also subsequent parenchymal damages due to mind edema, hydrocephalus, and also vascular alterations. Additionally, evidence suggests that toxins released from the infiltrated pathogens may contribute to neuropsychological deficits — treatment centers roughly immediate antibiotic therapy.

Traumatic and also atraumatic intracranial hemorrhages within various locations that the meninges space a common set of conditions that are directly related come the structure and function of the meninges and can it is in classified through their details location in ~ the meningeal layers. Because that example, one epidural hematoma is the collection of blood in the chop potential space between the dura and also the skull (i.e., the epidural space).<15> This condition is usually resulted in by the rupturing that the middle meningeal artery as a repercussion of the fracture of the temporal bone together a an outcome of head trauma. As the hemorrhage rapidly expands under arterial pressure, the dura peels far from the calvarium producing a lens-shaped biconvex hematoma, as viewed by a CT scan. As the hematoma compresses the underlying brain tissue, mind herniation deserve to occur and also lead to fatality unless treated through surgery. Various other intracranial hemorrhages include subdural hematomas, i beg your pardon usually an outcome from rupturing of the bridging veins and also the accumulation of blood in the potential subdural space between the dura and the arachnoid,<16> and subarachnoid hemorrhages, which occur in the subarachnoid space.

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<17> Subarachnoid hemorrhages are regularly further classified as nontraumatic (spontaneous) or traumatic; nontraumatic subarachnoid hemorrhages room usually a an outcome of a voluntary aneurysm (or rupture) of one artery in the an are between the arachnoid and also the pia and also present through a sudden onset headache.<18>