Morphological study of the efficacy of epidural blood patch in the cerebrospinal fluid hypovolemia with special reference to relationships of the CSF leaks and epidural lymphatic system
| Project/Area Number |
20590173
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
General anatomy (including Histology/Embryology)
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| Research Institution | Oita University |
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Principal Investigator |
MASAHIRO Miura Oita University, 医学部, 講師 (50199957)
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| Co-Investigator(Kenkyū-buntansha) |
UCHINO Tetuya 大分大学, 医学部, 助教 (70423697)
JI Ruiーcheng 大分大学, 医学部, 助教 (60305034)
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| Project Period (FY) |
2008 – 2010
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| Project Status |
Completed (Fiscal Year 2010)
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| Budget Amount *help |
¥4,810,000 (Direct Cost: ¥3,700,000、Indirect Cost: ¥1,110,000)
Fiscal Year 2010: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000)
Fiscal Year 2009: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
Fiscal Year 2008: ¥2,470,000 (Direct Cost: ¥1,900,000、Indirect Cost: ¥570,000)
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| Keywords | 硬膜外リンパ系 / 前リンパ管通液路 / 髄液漏出 / 硬膜外自己血注入療法 / 脳脊髄液減少症 / 自己静脈血注入療法 / 脈管外通液路 / 脳脊髄液側副吸収 / カニクイザル / 形態学的解析 / 硬膜外ブラッドパッチ / 脊髄髄膜 / 酵素組織化学 / 脊髄くも膜下角 / くも膜下角 |
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| Research Abstract |
Although cerebrospinal fluid hypovolemia (CFH) is typically caused by a spontaneous spinal cerebrospinal fluid (CSF) leak, the specific cause of non-physiological leaks is still far from understanding. At present, epidural blood patch (EBP) is a well-known treatment for various neurological symptoms resulting from the CFH attributable to CSF leaks. However, its morphological inhibitory effects are not sufficient details with the true nature of CSF leaks. Therefore, the main aim of this study is to elucidate the morphological mechanism of abnormal CSF leaks with special reference to the epidural lymphatic system (ELS) and prelymphatic channel (PLC) as CSF absorbing pathway on the spinal dura. In the present study, morphological evidence of the EBP treatment, especially the adhesive condition between the blood patch and the most frequent site of CSF leaks on the spinal dura was investigated electro-microscopically and enzyme-histochemically by using an epidural injection of the monkey's
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own blood. Whole-mount preparations and cryostat sections of the spinal dura were double stained with 5'-nucleotidase (5'-Nase) -alkaline phosphatase (ALPase) for identifying lymphatic and blood capillary vessels, respectively. The well-developed epidural lymphatic networks were analyzed in the spinal dura. A spinal dura mater with blood patches was observed in the light microscopy at 2 days, following an injection of blood into the epidural space from the cisterna magna. The part of two samples after EBP was observed in a condition of the fibrin sealant site under the scanning electron microscope (SEM). 5'-Nase-positive lymphatic networks and spinal arachnoid granulations (SAG) locally appeared in the subarachnoid angle (SAA) surrounding the cervical spinal nerve roots. In the SAA region of dorsal nerve root, epidural lymphatic vessels had numerous blind endings surrounding the SAG, and always situated in the epidural connective tissue layer including rich fatty mass (so-called fat pad). In the SEM observation, the dural component collagen fiber with rolling arrangements in the SAA region was relatively loose as compared with those in the general regions of the dorsal main portion. These findings may infer that the CSF physiological absorption ability via the ELS in the basilar dural structure of the spinal nerve roots was higher as compared with the structure of other dura mater region. The dura mater has suggested that the PLC may work physiologically as the CSF collateral transport pathway in the SAA region and closely relate to the abnormal acceleration of CSF leakage due to a mechanical expansion or defect in the spinal dural sac, while the well-developed fat pad may interfere with the bounding surface between blood patch and the SAA dura mater. Therefore, it may be difficult to seal directly the dural surface of SAA dura mater by the EBP. However, the EBP treatment may be expected as the transitory leak blocking by pushing indirectly an abnormal dilated dura mater via soft connective tissues including the intraepidural lymphatic vessels. Less
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Report
(4 results)
Research Products
(41 results)
