| El origen del espacio subdural raquídeo: hallazgos de ultra estructura |
The origin of the spinal subdural space: ultrastructure findings.
Reina MA, De Leon Casasola O, López A, De Andrés JA, Mora M, Fernández A.
Department of Anesthesiology and Critical Care, Hospital General de Móstoles, Hospital de Madrid Montepríncipe, Spain.miguelangel.rei@terra.es
Anesth Analg. 2002 Apr;94(4):991-5
Abstract
Previous studies of samples from cranial meninges have created doubts about the existence of a virtual subdural space. We examined the ultrastructure of spinal meninges from three human cadavers immediately after death to see whether there is a virtual subdural space at this level. The arachnoid mater had two portions: a compact laminar portion covering the dural sac internal surface and a trabecular portion extending like a spider web around the pia mater. There was a cellular interface between the laminar arachnoid and the internal layer of the dura that we called the dura-arachnoid interface. There was no subdural space in those specimens where the dura mater was macroscopically in continuity with the arachnoid trabecules. In the specimens where the dura mater was separated from the arachnoid, we found fissures in between the neurothelial cells that extended throughout the interface. We hypothesize that the subdural space would have its origin within the dura-arachnoid interface when the neurothelial cells break up, creating in this way a real subdural space. IMPLICATIONS: The subdural space was not seen under transmission electron microscopy in samples of human spinal meninges where surgical manipulation was avoided. Scanning electron microscopy in other samples showed the presence of broken neurothelial cells giving up fissures that extended along the dura-arachnoid interface. These findings may explain the origin of a real subdural space
http://www.anesthesia-analgesia.org/content/94/4/991.full.pdf+html
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| Inyección accidental intradural durante intento de bloqueo epidural. Informe de caso |
Accidental intradural injection during attempted epidural block -A case report-.
Yun JS, Kang SY, Cho JS, Choi JB, Lee YW.
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2011 Mar;60(3):205-8. Epub 2011 Mar 30.
Abstract
Several cases of accidental subdural injection have been reported, but only few of them are known to be accidental intradural injection during epidural block. Therefore we would like to report our experience of accidental intradural injection. A 68-year-old female was referred to our pain clinic due to severe metastatic spinal pain. We performed a diagnostic epidural injection at T9/10 interspace under the C-arm guided X-ray view. Unlike the usual process of block, onset was delayed and sensory dermatomes were irregular range. We found out a dense collection of localized radio-opaque contrast media on the reviewed X-ray findings. These are characteristic of intradural injection and clearly different from the narrow wispy bands of contrast in the subdural space
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| Colocación de catéter subdural intratecal: experiencia con dos casos. |
Subdural intrathecal catheter placement: experience with two cases.
Sorokin A, Annabi E, Yang WC, Kaplan R.
Montefiore Medical Center, Department of Anesthesiology, Bronx, NY 10467, USA. andrea.sorokin@mssm.edu
Pain Physician. 2008 Sep-Oct;11(5):677-80.
Abstract
BACKGROUND: Subdural migration of epidural catheters is well known and documented. Subdural placement of intrathecal catheters has not been recognized. Two cases of sudural placement of intrathecal catheters are presented. OBJECTIVE: The possibility of subdural migration of epidural catheters and its manifestations has been well documented. The following 2 cases demonstrate that intrathecal catheters can enter the subdural space upon placement. CASE REPORTS: The first case is a 52-year-old male with multiple sclerosis receiving a pump for intrathecal baclofen. It worked well for 10 years, but after 2 months of inadequate relief despite a 2-fold increase in baclofen, the catheter was imaged. The catheter pierced the arachnoid in the lower thoracic spine and tunneled subdural. It then pierced the arachnoid again, re-entering the cerebrospinal fluid (CSF) in the cephalad portion of the thoracic spine. Over time, the tip became covered with tissue, preventing direct CSF communication and causing subdural drug sequestration. The second case is a 54-year-old male with chronic bilateral lower extremity pain having a pump placed for pain control. Because of inadequate relief after implantation, the catheter was imaged. It pierced the arachnoid at L4-L5 but became subdural at T12-L1. At the time of surgical revision, the catheter was pulled back to L2. Repeat imaging showed it to be entirely subarachnoid, and analgesia was restored. CONCLUSIONS: These cases differ from others in the literature because the catheter was apparently subdural at the time of initial implantation. As these 2 cases demonstrate, this placement may manifest immediately, but it may remain undetected for a prolonged period. Initial subdural placement should be considered along with catheter migration into the subdural space in the differential of a malfunctioning pump
http://www.painphysicianjournal.com/2008/october/2008;11;677-680.pdf
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