DOCSLIB.ORG

Microvascular Anatomy of the Cerebellar Parafloccular Perforating Space

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Microvascular Anatomy of the Cerebellar Parafloccular Perforating Space LABORATORY INVESTIGATION J Neurosurg 124:440–449, 2016 Microvascular anatomy of the cerebellar parafloccular perforating space Pablo Sosa, MD,1 Manuel Dujovny, MD,2 Ibe Onyekachi, BS,2 Noressia Sockwell, BS,2 Fabián Cremaschi, MD,1 and Luis E. Savastano, MD3 1Department of Neuroscience, Clinical and Surgical Neurology, School of Medicine, National University of Cuyo, Mendoza, Argentina; 2Departments of Neurosurgery and Electrical Engineering, Wayne State University, Detroit; and 3Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan OBJECTIVE The cerebellopontine angle is a common site for tumor growth and vascular pathologies requiring surgical manipulations that jeopardize cranial nerve integrity and cerebellar and brainstem perfusion. To date, a detailed study of vessels perforating the cisternal surface of the middle cerebellar peduncle—namely, the paraflocculus or parafloccular perforating space—has yet to be published. In this report, the perforating vessels of the anterior inferior cerebellar artery (AICA) in the parafloccular space, or on the cisternal surface of the middle cerebellar peduncle, are described to eluci- date their relevance pertaining to microsurgery and the different pathologies that occur at the cerebellopontine angle. METHODS Fourteen cadaveric cerebellopontine cisterns (CPCs) were studied. Anatomical dissections and analysis of the perforating arteries of the AICA and posterior inferior cerebellar artery at the parafloccular space were recorded using direct visualization by surgical microscope, optical histology, and scanning electron microscope. A comprehensive review of the English-language and Spanish-language literature was also performed, and findings related to anatomy, histology, physiology, neurology, neuroradiology, microsurgery, and endovascular surgery pertaining to the cerebellar flocculus or parafloccular spaces are summarized. RESULTS A total of 298 perforating arteries were found in the dissected specimens, with a minimum of 15 to a maxi- mum of 26 vessels per parafloccular perforating space. The average outer diameter of the cisternal portion of the perfo- rating arteries was 0.11 ± 0.042 mm (mean ± SD) and the average length was 2.84 ± 1.2 mm. Detailed schematics and the surgical anatomy of the perforating vessels at the CPC and their clinical relevance are reported. CONCLUSIONS The parafloccular space is a key entry point for many perforating vessels toward the middle cerebellar peduncle and lateral brainstem, and it must be respected and protected during surgical approaches to the cerebellopon- tine angle. http://thejns.org/doi/abs/10.3171/2015.2.JNS142693 KEY WORDS cerebellum; cerebellopontine cistern; cerebellopontine angle; anterior inferior cerebellar artery; posterior inferior cerebellar artery; perforating vessels; parafloccular perforating space; middle cerebellar peduncle; anatomy HE surgical anatomy of the cerebellopontine angle nal surface of the middle cerebellar peduncle lateral to the (CPA) is complex and challenging. The cerebello- cerebellar flocculus—namely, the paraflocculus or para- pontine cistern (CPC) lies in the CPA between the floccular perforating space—is particularly susceptible to brainstem,T cerebellum, and petrous portion of the tempo- the abovementioned surgical manipulation from a retro- ral bone and is crossed by multiple delicate nerves and sigmoid approach, which is the workhorse approach for small vessels directed toward the cerebellum and highly CPA lesions. The importance of this small but key area in eloquent portions of the brainstem. This region often wit- the cerebellopontine interface was recognized in a classic nesses vascular pathology and tumors, leading to lengthy article by David and Askenasy in the 1930s,14 and previ- cerebellar retraction, dissection, and the use of bipolar co- ously published articles have described its topographic agulation that jeopardizes the integrity of cranial nerves relationship to the major branches of the anterior inferior (CNs) and cerebellar and brainstem perfusion. The cister- cerebellar artery (AICA) and posterior inferior cerebellar ABBREVIATIONS AICA = anterior inferior cerebellar artery; CN = cranial nerve; CPA = cerebellopontine angle; CPC = cerebellopontine cistern; PICA = posterior inferior cerebellar artery; SCA = superior cerebellar artery. SUBMITTED November 25, 2014. ACCEPTED February 25, 2015. INCLUDE WHEN CITING Published online September 4, 2015; DOI: 10.3171/2015.2.JNS142693. 440 J Neurosurg Volume 124 • February 2016 ©AANS, 2016 Unauthenticated | Downloaded 10/01/21 06:02 PM UTC Microvascular anatomy of parafloccular perforating space artery (PICA).19,21,34,42,44 However, a detailed study of the the CPC, an additional head was harvested at the neck perforating vessels entering the parafloccular space has and perfused with 2% formaldehyde solution. It was then not yet been published. Here, we review the microsurgi- perfused with red latex via both carotid arteries and both cal anatomy of the CPC and describe in detail the vessels vertebral arteries, and with blue latex via both internal that perforate the parafloccular space and distribute within jugular veins. The brain was then harvested, the CPC was the lateral pons and deep cerebellum. It is our expectation dissected, and high-resolution images of the perforating that this study will add knowledge to the microanatomy of vessels were obtained using a digital camera. Finally, an the CPA and help decrease morbidity and mortality from additional cadaveric brain was harvested, and intraarterial surgical procedures involving this region.6 injections of red latex into the AICA and blue latex into the PICA were performed to identify AICA-PICA anas- tomosis and dual perfusion over the flocculus and para- Methods flocculus. The cadaveric specimens were obtained from A search of the English- and Spanish-language lit- the Department of Anatomy at the Medical School of the erature was performed using the PubMed, BioMed, and National University of Cuyo and the Anatomical Dona- Google Scholar scientific databases using the following tion Program of the University of Michigan, and all pro- key indexing terms: cerebellopontine angle, cerebellar cedures adhered to institutional guidelines and approved flocculus, cerebellar paraflocculus, parafloccular space, protocols. brainstem perforating vessels, and anteroinferior cerebel- lar artery, in combination with anatomy, histology, physi- ology, neurology, neuroradiology, microsurgery, endovas- Results cular surgery, surgical complications, and stroke. Then, 7 The CPC and Subdivisions macroscopically normal brains were harvested from adult human cadavers without known histories of stroke, demen- As described by Rhoton,52 the CPC lies between the tia, malignancy, trauma, or neurosurgical intervention. The anterolateral surface of the pons and cerebellum and the specimens were cleaned with saline solution and then were arachnoid membrane that faces the petrous bone and is fixed using 2% formaldehyde solution. Next, the 7 cerebel- contained superiorly by the lateral pontomesencephalic lums were isolated, the intradural vertebral arteries were membrane, inferiorly by the lateral pontomedullary mem- catheterized using appropriately sized catheters, and the brane, medially by the anterior pontine membrane, and basilar arteries were ligated distally to the origin of the extends laterally along the cerebellopontine fissure. To fo- AICA and proximally to the basilar bifurcation. The form- cus our dissection on the region of interest and organize aldehyde solution within the vasculature was rinsed with our results, we subdivided the CPC into superior, middle, normal saline, and red latex was used for arterial filling. and inferior cisternal portions (Fig. 1). The superior cister- A Wild M5A surgical microscope (Wild Heerbrugg) was nal portion extends from the lateral pontomesencephalic used for dissections using 6–12× magnification. A total of membrane superolaterally, the anterior pontine mem- 14 CPCs were dissected and subdivided into the superior, brane medially, and a transversal line (superior cisternal middle, and inferior cisternal portions in order to organize line) that extends from the horizontal cerebellar fissure the anatomical analysis. The arachnoid of the CPC was and passes immediately caudal to the apparent origin of opened under the surgical microscope utilizing the immer- the trigeminal nerve inferiorly. Within this portion we sion technique, and the foramina of Luschka were identi- consistently found the superior cerebellar artery (SCA), fied. The lateral pontine (a2) and flocculopeduncular (a3) branches of the vein of the cerebellopontine fissure, the segments of the AICAs and the tonsillomedullary (p3) and transverse pontine vein, trigeminal CN, and the medial 53 telovelotonsillar (p4) segments of the PICAs were freed part of the superior limb of the superior cerebellopontine of the arachnoid, and the perforating vessels to the para- fissure (Fig. 1). The neural structures within this portion flocculus space were examined. Specifically, we measured were largely perfused by the SCA branches. The middle the number, origin from the main vessel, outer diameter, cisternal portion extended from the superior cisternal line length, branching pattern, and penetrating points in the to a transversal line (inferior cisternal line) that extends paraflocculus. High-resolution images of the perforating from the cerebellar horizontal fissure to the inferior edge arteries were obtained
Load more

Recommended publications
  • Pharnygeal Arch Set - Motor USMLE, Limited Edition > Neuroscience > Neuroscience
    CNs 5, 7, 9, 10 - Pharnygeal Arch Set - Motor USMLE, Limited Edition > Neuroscience > Neuroscience PHARYNGEAL ARCH SET, CNS 5, 7, 9, 10 • They are derived from the pharyngeal (aka branchial) arches • They have special motor and autonomic motor functions CRANIAL NERVES EXIT FROM THE BRAINSTEM CN 5, the trigeminal nerve exits the mid/lower pons.* CN 7, the facial nerve exits the pontomedullary junction.* CN 9, the glossopharyngeal nerve exits the lateral medulla.* CN 10, the vagus nerve exits the lateral medulla.* CRANIAL NERVE NUCLEI AT BRAINSTEM LEVELS Midbrain • The motor trigeminal nucleus of CN 5. Nerve Path: • The motor division of the trigeminal nerve passes laterally to enter cerebellopontine angle cistern. Pons • The facial nucleus of CN 7. • The superior salivatory nucleus of CN 7. Nerve Path: • CN 7 sweeps over the abducens nucleus as it exits the brainstem laterally in an internal genu, which generates a small bump in the floor of the fourth ventricle: the facial colliculus • Fibers emanate from the superior salivatory nucleus, as well. Medulla • The dorsal motor nucleus of the vagus, CN 10 • The inferior salivatory nucleus, CN 9 1 / 3 • The nucleus ambiguus, CNs 9 and 10. Nerve Paths: • CNs 9 and 10 exit the medulla laterally through the post-olivary sulcus to enter the cerebellomedullary cistern. THE TRIGEMINAL NERVE, CN 5  • The motor division of the trigeminal nerve innervates the muscles of mastication • It passes ventrolaterally through the cerebellopontine angle cistern and exits through foramen ovale as part of the mandibular division (CN 5[3]). Clinical Correlation - Trigeminal Neuropathy THE FACIAL NERVE, CN 7  • The facial nucleus innervates the muscles of facial expression • It spans from the lower pons to the pontomedullary junction.
    [Show full text]
  • The Cerebellum in Sagittal Plane-Anatomic-MR Correlation: 2
    667 The Cerebellum in Sagittal Plane-Anatomic-MR Correlation: 2. The Cerebellar Hemispheres Gary A. Press 1 Thin (5-mm) sagittal high-field (1 .5-T) MR images of the cerebellar hemispheres James Murakami2 display (1) the superior, middle, and inferior cerebellar peduncles; (2) the primary white­ Eric Courchesne2 matter branches to the hemispheric lobules including the central, anterior, and posterior Dean P. Berthoty1 quadrangular, superior and inferior semilunar, gracile, biventer, tonsil, and flocculus; Marjorie Grafe3 and (3) several finer secondary white-matter branches to individual folia within the lobules. Surface features of the hemispheres including the deeper fissures (e.g., hori­ Clayton A. Wiley3 1 zontal, posterolateral, inferior posterior, and inferior anterior) and shallower sulci are John R. Hesselink best delineated on T1-weighted (short TRfshort TE) and T2-weighted (long TR/Iong TE) sequences, which provide greatest contrast between CSF and parenchyma. Correlation of MR studies of three brain specimens and 11 normal volunteers with microtome sections of the anatomic specimens provides criteria for identifying confidently these structures on routine clinical MR. MR should be useful in identifying, localizing, and quantifying cerebellar disease in patients with clinical deficits. The major anatomic structures of the cerebellar vermis are described in a companion article [1). This communication discusses the topographic relationships of the cerebellar hemispheres as seen in the sagittal plane and correlates microtome sections with MR images. Materials, Subjects, and Methods The preparation of the anatomic specimens, MR equipment, specimen and normal volunteer scanning protocols, methods of identifying specific anatomic structures, and system of This article appears in the JulyI August 1989 issue of AJNR and the October 1989 issue of anatomic nomenclature are described in our companion article [1].
    [Show full text]
  • Basal Ganglia & Cerebellum
    1/2/2019 This power point is made available as an educational resource or study aid for your use only. This presentation may not be duplicated for others and should not be redistributed or posted anywhere on the internet or on any personal websites. Your use of this resource is with the acknowledgment and acceptance of those restrictions. Basal Ganglia & Cerebellum – a quick overview MHD-Neuroanatomy – Neuroscience Block Gregory Gruener, MD, MBA, MHPE Vice Dean for Education, SSOM Professor, Department of Neurology LUHS a member of Trinity Health Outcomes you want to accomplish Basal ganglia review Define and identify the major divisions of the basal ganglia List the major basal ganglia functional loops and roles List the components of the basal ganglia functional “circuitry” and associated neurotransmitters Describe the direct and indirect motor pathways and relevance/role of the substantia nigra compacta 1 1/2/2019 Basal Ganglia Terminology Striatum Caudate nucleus Nucleus accumbens Putamen Globus pallidus (pallidum) internal segment (GPi) external segment (GPe) Subthalamic nucleus Substantia nigra compact part (SNc) reticular part (SNr) Basal ganglia “circuitry” • BG have no major outputs to LMNs – Influence LMNs via the cerebral cortex • Input to striatum from cortex is excitatory – Glutamate is the neurotransmitter • Principal output from BG is via GPi + SNr – Output to thalamus, GABA is the neurotransmitter • Thalamocortical projections are excitatory – Concerned with motor “intention” • Balance of excitatory & inhibitory inputs to striatum, determine whether thalamus is suppressed BG circuits are parallel loops • Motor loop – Concerned with learned movements • Cognitive loop – Concerned with motor “intention” • Limbic loop – Emotional aspects of movements • Oculomotor loop – Concerned with voluntary saccades (fast eye-movements) 2 1/2/2019 Basal ganglia “circuitry” Cortex Striatum Thalamus GPi + SNr Nolte.
    [Show full text]
  • Bilateral Cerebellar Dysfunctions in a Unilateral Meso-Diencephalic Lesion
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.44.4.361 on 1 April 1981. Downloaded from Journal of Neurology, Neurosurgery, and Psychiatry, 1981, 44, 361-363 Short report Bilateral cerebellar dysfunctions in a unilateral meso-diencephalic lesion D VON CRAMON From the Max-Planck-Institute for Psychiatry, Munich, Germany SUMMARY The clinical syndrome of a 65-year-old patient with a slit-shaped right-sided meso- diencephalic lesion was analysed. A cerebellar syndrome with limb-kinetic ataxia, intention tremor and hypotonicity in all extremities as well as ataxic dysarthria was found. The disruption of the two cerebello-(rubro)-thalamic pathways probably explained the signs of bilateral cere- bellar dysfunction. The uncrossed ascending limb of the right, and the crossed one of the left brachium conjunctivum may have been damaged by the unilateral lesion extending between caudal midbrain and dorsal thalamus. Protected by copyright. Most of the fibres which constitute the superior general hospital where neurological examination cerebellar peduncle leave the cerebellum and showed bilateral miosis, convergent strabism, vertical originate in cells of the dentate nucleus but also gaze paresis on upward gaze with gaze-paretic nystag- arise from neurons of the globose and emboli- mus, flaccid sensori-motor hemiparesis with increased stretch reflexes and Babinski sign on the left side, forme nuclei. The crossed ascending fibres of the and dysmetric movements of the right upper extremity. brachia conjunctiva constitute the major outflow The CT scan showed an acute haemorrhage in the from the cerebellum, they form the cerebello- right mesodiencephalic area. On 19 February 1979 (rubro)-thalamic and dentato-thalamic tracts.' the patient was admitted to our department.
    [Show full text]
  • Facial Nerve Disorders Cn7 (1)
    FACIAL NERVE DISORDERS CN7 (1) Facial Nerve Disorders Last updated: January 18, 2020 FACIAL PALSY .......................................................................................................................................... 1 ETIOLOGY .............................................................................................................................................. 1 GUIDE TO LESION SITE LOCALIZATION ................................................................................................... 2 CLINICAL GRADING OF SEVERITY .......................................................................................................... 2 House-Brackmann grading scale ........................................................................................... 2 CLINICO-ANATOMICAL SYNDROMES ..................................................................................................... 2 Supranuclear (Central) Palsy ................................................................................................. 2 Nuclear Lesion ...................................................................................................................... 3 Cerebellopontine Angle Syndrome ....................................................................................... 3 Facial Canal Syndrome ......................................................................................................... 3 Stylomastoid Foramen Syndrome ........................................................................................
    [Show full text]
  • The Clinical Treatment and Outcome of Cerebellopontine Angle
    www.nature.com/scientificreports OPEN The clinical treatment and outcome of cerebellopontine angle medulloblastoma: a retrospective study of 15 cases Tao Wu 1,4, Pei-ran Qu3,4, Shun Zhang2, Shi-wei Li1, Jing Zhang1, Bo Wang2, Pinan Liu 1,2, Chun-de Li1,2 & Fu Zhao 1,2 ✉ Medulloblastoma (MB) is the most common malignant pediatric brain tumor arising in the cerebellum or the 4th ventricle. Cerebellopontine angle (CPA) MBs are extremely rare tumors, with few cases previously described. In this study, we sought to describe the clinical characteristics, molecular features and outcomes of CPA MB. We retrospectively reviewed a total of 968 patients who had a histopathological diagnosis of MB at the Beijing Neurosurgical Institute between 2002 and 2016. The demographic characteristics, clinical manifestations and radiological features were retrospectively analyzed. Molecular subgroup was evaluated by the expression profling array or immunohistochemistry. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier analysis. In this study, 15 patients (12 adults and 3 children) with a mean age at diagnosis of 25.1 years (range 4–45 years) were included. CPA MBs represented 1.5% of the total cases of MB (15/968). Two molecular subgroups were identifed in CPA MBs: 5 WNT-MBs (33%) and 10 SHH-MBs (67%). CPA WNT-MBs had the extracerebellar growth with the involvement of brainstem (P = 0.002), whereas CPA SHH-MBs predominantly located within the cerebellar hemispheres (P = 0.004). The 5-year OS and PFS rates for CPA MB were 80.0% ± 10.3% and 66.7% ± 12.2%, respectively.
    [Show full text]
  • Occurrence of Long-Term Depression in the Cerebellar Flocculus During Adaptation of Optokinetic Response Takuma Inoshita, Tomoo Hirano*
    SHORT REPORT Occurrence of long-term depression in the cerebellar flocculus during adaptation of optokinetic response Takuma Inoshita, Tomoo Hirano* Department of Biophysics, Graduate School of Science, Kyoto University, Sakyo-ku, Japan Abstract Long-term depression (LTD) at parallel fiber (PF) to Purkinje cell (PC) synapses has been considered as a main cellular mechanism for motor learning. However, the necessity of LTD for motor learning was challenged by demonstration of normal motor learning in the LTD-defective animals. Here, we addressed possible involvement of LTD in motor learning by examining whether LTD occurs during motor learning in the wild-type mice. As a model of motor learning, adaptation of optokinetic response (OKR) was used. OKR is a type of reflex eye movement to suppress blur of visual image during animal motion. OKR shows adaptive change during continuous optokinetic stimulation, which is regulated by the cerebellar flocculus. After OKR adaptation, amplitudes of quantal excitatory postsynaptic currents at PF-PC synapses were decreased, and induction of LTD was suppressed in the flocculus. These results suggest that LTD occurs at PF-PC synapses during OKR adaptation. DOI: https://doi.org/10.7554/eLife.36209.001 Introduction The cerebellum plays a critical role in motor learning, and a type of synaptic plasticity long-term *For correspondence: depression (LTD) at parallel fiber (PF) to Purkinje cell (PC) synapses has been considered as a primary [email protected]. cellular mechanism for motor learning (Ito, 1989; Hirano, 2013). However, the hypothesis that LTD ac.jp is indispensable for motor learning was challenged by demonstration of normal motor learning in Competing interests: The rats in which LTD was suppressed pharmacologically or in the LTD-deficient transgenic mice authors declare that no (Welsh et al., 2005; Schonewille et al., 2011).
    [Show full text]
  • Lipoma of the Midbrain
    LIPOMA OF THE MIDBRAIN POST-MORTEM FINDING IN A PATIENT WITH BREAST CANCER VERÔNICA MAIA GOUVEA * — MYRIAM DUMAS HAHN ** — LEILA CHIMELLI ** SUMMARY — Intracranial lipomas are rare, usually do not have clinical expression and are located mare frequently in the corpus callosum. Other locations include the spinal cord, midbrain tectum, superior vermis, tuber cinereum, infundibulum and more rarely cerebello­ pontine angle, hypothalamus, superior medullary velum and insula. We report the case of a lipoma of the left inferior colliculus which was a post-mortem finding in a woman who died of breast cancer. Although there are reports of intracranial lipomas in patients with malignant tumors there is no explanation for the co-existence of the two tumors. The present tumor also includes a segment of a nerve which is not uncommon, but a less common finding was the presence of nests of Schwann cells within it, shown by immunohistochemistry. Lipoma do mesencéfalo: achado de necrópsia, em paciente com câncer da mama. RESUMO — Lipomas intracranianos são raros, em geral sem expressão clínica, localizados mais freqüentemente no corpo caloso. Outras localizações incluem medula espinhal, teto mesencefálico, vermis superior, tuber cinereum, infundibulum e mais raramente o ângulo ponto-cerebelar, hipotálamo, véu medular superior e insula. Relatamos o achado de necrópsia de um lipoma do colículo inferior esquerdo em uma mulher com câncer de mama. Embora haja relatos de lipomas intracranianos em pacientes com tumores malignos não há explicação para a co-existência dos dois tumores. O presente tumor também inclui o segmento de um nervo, o que não é incomum, mas um achado menos comum foi a presença de ninhos de células de Schwann no tumor, mostradas por imuno-histoquímica.
    [Show full text]
  • Anatomy of the Brainstem
    Anatomy of the Brainstem Neuroanatomy block-Anatomy-Lecture 5 Editing file Objectives At the end of the lecture, students should be able to: 01 List the components of brain stem. 02 Describe the site of brain stem 03 Describe the relations between components of brain stem & their relations to cerebellum. 04 Describe the external features of both ventral & dorsal surfaces of brain stem Color guide 05 List cranial nerves emerging from brain stem 06 Describe the site of emergence of each cranial nerve ● Only in boys slides in Green ● Only in girls slides in Purple ● important in Red ● Notes in Grey Development of Brain Brain stem ● The brain develops from the cranial part of neural tube. ● The brainstem is the region of the brain that connects the ● The cranial part is divided into 3 parts: cerebrum with the spinal cord. ● Site: It lies on the basilar part of occipital bone (clivus). - Subdivided into: ● Parts from above downwards : 1. Telencephalon: (cavities: 2 lateral ventricles) 1. Midbrain Two cerebral hemispheres. Forebrain 2. Pons 2. Diencephalon: (cavity: 3rd ventricle) 3. Medulla oblongata thalamus, hypothalamus, epithalamus & subthalamus ● Connection with cerebellum: Each part of the brain stem is connected to the Midbrain - (cavity: cerebral aqueduct) cerebellum by cerebellar peduncles (superior, middle & inferior). - (cavity: 4th ventricle) - Subdivided into: Hindbrain 1. Pons 2. Cerebellum 3. Medulla oblongata 3 Sagittal section of Brain 4 Functions of the Brain Stem Pathway of tracts between cerebral cortex & spinal cord (ascending and descending tracts). 1 Site of origin of nuclei of cranial nerves (from 3rd to 12th). 2 Site of emergence of cranial nerves (from 3rd to 12th).
    [Show full text]
  • High-Yield Neuroanatomy
    LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page i Aptara Inc. High-Yield TM Neuroanatomy FOURTH EDITION LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page ii Aptara Inc. LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page iii Aptara Inc. High-Yield TM Neuroanatomy FOURTH EDITION James D. Fix, PhD Professor Emeritus of Anatomy Marshall University School of Medicine Huntington, West Virginia With Contributions by Jennifer K. Brueckner, PhD Associate Professor Assistant Dean for Student Affairs Department of Anatomy and Neurobiology University of Kentucky College of Medicine Lexington, Kentucky LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page iv Aptara Inc. Acquisitions Editor: Crystal Taylor Managing Editor: Kelley Squazzo Marketing Manager: Emilie Moyer Designer: Terry Mallon Compositor: Aptara Fourth Edition Copyright © 2009, 2005, 2000, 1995 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street 530 Walnut Street Baltimore, MD 21201 Philadelphia, PA 19106 Printed in the United States of America. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at [email protected], or via website at http://www.lww.com (products and services).
    [Show full text]
  • The Meninges As Barriers and Facilitators for the Movement of Fluid, Cells and Pathogens Related to the Rodent and Human CNS
    The meninges as barriers and facilitators for the movement of fluid, cells and pathogens related to the rodent and human CNS Weller, Roy O.; Sharp, Matthew M.; Christodoulides, Myron; Carare, Roxana O.; Møllgård, Kjeld Published in: Acta Neuropathologica DOI: 10.1007/s00401-018-1809-z Publication date: 2018 Document version Publisher's PDF, also known as Version of record Document license: CC BY Citation for published version (APA): Weller, R. O., Sharp, M. M., Christodoulides, M., Carare, R. O., & Møllgård, K. (2018). The meninges as barriers and facilitators for the movement of fluid, cells and pathogens related to the rodent and human CNS. Acta Neuropathologica, 135(3), 363-385. https://doi.org/10.1007/s00401-018-1809-z Download date: 28. Sep. 2021 Acta Neuropathologica (2018) 135:363–385 https://doi.org/10.1007/s00401-018-1809-z REVIEW The meninges as barriers and facilitators for the movement of fuid, cells and pathogens related to the rodent and human CNS Roy O. Weller1 · Matthew M. Sharp1 · Myron Christodoulides2 · Roxana O. Carare1 · Kjeld Møllgård3 Received: 5 November 2017 / Revised: 2 January 2018 / Accepted: 15 January 2018 / Published online: 24 January 2018 © The Author(s) 2018. This article is an open access publication Abstract Meninges that surround the CNS consist of an outer fbrous sheet of dura mater (pachymeninx) that is also the inner peri- osteum of the skull. Underlying the dura are the arachnoid and pia mater (leptomeninges) that form the boundaries of the subarachnoid space. In this review we (1) examine the development of leptomeninges and their role as barriers and facilita- tors in the foetal CNS.
    [Show full text]
  • High-Yield Neuroanatomy, FOURTH EDITION
    LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page i Aptara Inc. High-Yield TM Neuroanatomy FOURTH EDITION LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page ii Aptara Inc. LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page iii Aptara Inc. High-Yield TM Neuroanatomy FOURTH EDITION James D. Fix, PhD Professor Emeritus of Anatomy Marshall University School of Medicine Huntington, West Virginia With Contributions by Jennifer K. Brueckner, PhD Associate Professor Assistant Dean for Student Affairs Department of Anatomy and Neurobiology University of Kentucky College of Medicine Lexington, Kentucky LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page iv Aptara Inc. Acquisitions Editor: Crystal Taylor Managing Editor: Kelley Squazzo Marketing Manager: Emilie Moyer Designer: Terry Mallon Compositor: Aptara Fourth Edition Copyright © 2009, 2005, 2000, 1995 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street 530 Walnut Street Baltimore, MD 21201 Philadelphia, PA 19106 Printed in the United States of America. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at [email protected], or via website at http://www.lww.com (products and services).
    [Show full text]