Anatomy and development of the meninges: implications for subdural collections and CSF circulation

Abstract

The dura is traditionally viewed as a supportive fibrous covering of the brain containing the dural venous sinuses but otherwise devoid of vessels and lacking any specific function. However, review of the embryology and anatomy reveals the dura to be a complex, vascularized and innervated structure, not a simple fibrous covering. The dura contains an inner vascular plexus that is larger in the infant than in the adult, and this plexus likely plays a role in CSF absorption. This role could be particularly important in the infant whose arachnoid granulations are not completely developed. Although subdural hemorrhage is frequently traumatic, there are nontraumatic conditions associated with subdural hemorrhage, and the inner dural plexus is a likely source of bleeding in these nontraumatic circumstances. This review outlines the development and age-specific vascularity of the dura and offers an alternative perspective on the role of the dura in homeostasis of the central nervous system.

Local application of corticosteroids combined with surgery for the treatment of chronic subdural hematoma

“…CSH is currently considered to be a circumscribed chronic self-perpetuating inflammatory disorder that involves the dura mater (23). When CSF or extravasated blood gathers into the restricted area of the dural border cell layer (10,14,17), it evokes a local aseptic inflammatory (9,26) and inflammation-induced angiogenic reactions (11,12,22,25). The result is that glucocorticoids may specifically impede the formation of neomembranes and neo-capillaries by their powerful inhibition of inflammatory mediators (23).…”

The creation of non-disease: an assault on the diagnosis of child abuse

“…The course was preceded by a 1-day discussion between the speakers and other invited experts. The following day-anda-half seminar (Table 1, course outline) presented the scientifically accepted methodology for the diagnosis of nonaccidental trauma with emphasis on the pathophysiology of various injuries, and covered areas where new data have changed our understanding (e.g., subdural hematoma can occur from bleeding dural veins and not only bridging veins) [20][21][22]. The differential diagnosis of the various injuries was emphasized and appropriate workup of these children was presented.…”

The emperor has no clothes

“…Sir, The paper by Mack et al [1] would, by the title, appear to be a straightforward exposition of developmental anatomy and pathophysiology of CSF and extracerebral accumulation of fluid. Instead, the authors raise reasonable doubt regarding the traumatic origin of subdural hematoma (SDH) in infants.…”