In vitro determination of human dura mater permeability to opioids and local anaesthetics

McEllistrem, Richard E.; Bennington, Ronald G.; Roth, Sheldon H.

doi:10.1007/bf03011315

Cited by 30 publications

(7 citation statements)

References 15 publications

(1 reference statement)

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“…Similar drug administrations are also frequently used for lower abdominal, urogenital, rectal, and lower extremity surgery (Morgan et al, 2006). These treatments are based on the in vitro–verified passage of local anesthetics and narcotics through the spinal meninges (McEllistrem and Bennington, 1993; Grouls et al, 2000). Spinal intrathecal baclofen therapy is also acknowledged to be effective in the relief of spasticity and pain associated with cerebral palsy, sclerosis multiplex, and other neurologic disorders (Guillaume et al, 2005; Ben Smail et al, 2006).…”

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confidence: 99%

Epidural Pentobarbital Delivery Can Prevent Locally Induced Neocortical Seizures in Rats: The Prospect of Transmeningeal Pharmacotherapy for Intractable Focal Epilepsy

et al. 2006

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Summary:Purpose: To determine whether epidural pentobarbital (PB) delivery can prevent and/or terminate neocortical seizures induced by locally administered acetylcholine (Ach) in freely moving rats.Methods: Rats were implanted permanently with an epidural cup placed over the right parietal cortex with intact dura mater. Epidural screw-electrodes, secured to the cup, recorded local neocortical EEG activity. In the seizure-termination study, Ach was delivered into the epidural cup, and after the development of electrographic and behavioral seizures, the Ach solution was replaced with either PB or artificial cerebrospinal fluid (aCSF; control solution). In the seizure-prevention study, the epidural Ach delivery was preceded by a 10-min exposure of the delivery site to PB or aCSF. Raw EEG recordings, EEG power spectra, and behavioral events were analyzed.Results: Ach-induced EEG seizures associated with convulsions, which were unaffected by epidural aCSF applications, were terminated by epidurally delivered PB within 2-2.5 min. Epidural deliveries of PB before Ach applications completely prevented the development of electrographic and behavioral seizures, whereas similar deliveries of aCSF exerted no influence on the seizure-generating potential of Ach.Conclusions: This study showed for the first time that epidural AED delivery can prevent, as well as terminate, locally induced neocortical seizures. The findings support the viability of transmeningeal pharmacotherapy for the treatment of intractable neocortical epilepsy.

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confidence: 99%

Epidural Pentobarbital Delivery Can Prevent Locally Induced Neocortical Seizures in Rats: The Prospect of Transmeningeal Pharmacotherapy for Intractable Focal Epilepsy

et al. 2006

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“…In the present study, laminectomy-induced cauda equina adhesion was also enhanced by kaolin. It is speculated that an increased severity of the epidural inflammation may affect the cauda equina because some inflammatory substances may pass through the dura mater [17] or may perfuse through the rapid transport route between the epidural space and the intraneural capillaries of the nerve roots [4]. Moreover, in the previous study, when cauda equina adhesion occurred in the kaolin group, nerve degeneration was observed in three of five rats at 1 week after surgery [33].…”

Section: Discussionmentioning

confidence: 93%

Nutritional supply to the cauda equina in lumbar adhesive arachnoiditis in rats

Miaki

Matsui

Nakano

et al. 1999

European Spine Journal

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IntroductionAdhesive spinal arachnoiditis in the lumbar spine is considered to be a sequence of inflammatory changes in the cauda equina and the pia-arachnoid membrane. The possible etiologic factors have been reported as infections [6], prolapsed intervertebral disc [7,8,23], spinal surgery [1,22,26,28], myelographic dyes [2,7,11,12], and spinal anesthesia [1,22]. Recently, clumping of the cauda equina in the central and peripheral region in the thecal sac has been described in MRI studies [5,15,24]. To date, among the possible etiologic factors in lumbar adhesive arachnoiditis, posterior surgical intervention to the lumbar spine seems to be the most possible and frequently associated cause. In the previous study, it was reported that tranAbstract Laminectomy-induced cauda equina adhesion has been proved by rat experiments and postoperative serial MRI in humans. A degenerative change of the cauda equina has been proved when cauda equina adhesion has been prolonged. Since it has not been reported how the nutritional supply is changed in such a condition, we evaluated the glucose supply to the adhered cauda equina in rats. Wistar rats were divided into the following three groups: the control group which received no operation, the laminectomy group which underwent L5-L6 laminectomy only, and the koalin group which received 5 mg of kaolin on the dorsal extradural space following L5-L6 laminectomy. Based on 3 H-methyl-glucose uptake study, we analyzed (1) glucose transport from the intraneural vessels to the nerve tissue, and (2) glucose transport from the cerebrospinal fluid to the nerve tissue. We evaluated the relation between the severity of cauda equina adhesion and 3 H uptake into the cauda equina. Cauda equina adhesion was observed in 2 of 12 rats in the control group, in 3 of 12 rats in the laminectomy group, and in 18 of 20 rats in the kaolin group. In the 3 H-methyl-glucose uptake study, at 12 weeks the glucose transport to the cauda equina from the vessels increased by 44%, and that from the cerebrospinal fluid decreased by 64% in the kaolin group compared with thecontrol group. In the condition of complete cauda equina adhesion, the glucose transport to the cauda equina from the vessels increased by 53% and that from the cerebrospinal fluid remarkably decreased by 72% compared with the normal cauda equina. Considering the greater nutritional importance of the cerebrospinal fluid in the cauda equina, it is most likely that the impairment of nutritional supply to adhered cauda equina may lead to eventual neural degeneration.

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“…9 Pearce and Grimmer 10 reported that the amount of elastin in tissues decreases with age and that reduced elastin content significantly affects biomechanical strength. McEllistrem et al 11 reported that agerelated structural changes to the dura mater may account for the increased dural permeability. Hence, degenerative changes to the dura mater may induce weakening or increased permeability.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Cerebrospinal Fluid Leakage Associated With Total En Bloc Spondylectomy

Yokogawa¹,

Murakami²,

Demura³

et al. 2015

Orthopedics

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Cerebrospinal fluid (CSF) leakage is a serious postoperative complication associated with total en bloc spondylectomy. The authors examined the risk factors for CSF leakage after this procedure. A total of 72 patients underwent total en bloc spondylectomy at the authors' institution between May 2010 and April 2013. Postoperative CSF leakage was observed in 17 of the 72 patients (23.6%). The results of univariate analysis suggested that age 54 years or older, preoperative surgical site irradiation, resection of 3 or more vertebral bodies, and dural injury were significant risk factors for postoperative CSF leakage after total en bloc spondylectomy. Multivariate analysis showed that preoperative surgical site irradiation was the only significant risk factor for postoperative CSF leakage (adjusted odds ratio, 5.22; 95% confidence interval, 1.03-26.45, P=.046). The authors also assessed the course of treatment for postoperative CSF leakage in each patient. Of 17 patients with postoperative CSF leakage, 13 recovered without further complications, but 4 required reoperation (2 for wound dehiscence, 1 for surgical site infection, and 1 for severe intracranial hypotension). All 4 patients who required reoperation had a history of surgical site irradiation. Thus, this study suggests that careful consideration should be given to postoperative CSF leakage in patients with a history of surgical site irradiation. These findings may contribute to the management of postoperative CSF leakage associated with total en bloc spondylectomy and supplement the information given to the patient in the process of obtaining informed consent.

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In vitro determination of human dura mater permeability to opioids and local anaesthetics

Cited by 30 publications

References 15 publications

Epidural Pentobarbital Delivery Can Prevent Locally Induced Neocortical Seizures in Rats: The Prospect of Transmeningeal Pharmacotherapy for Intractable Focal Epilepsy

Epidural Pentobarbital Delivery Can Prevent Locally Induced Neocortical Seizures in Rats: The Prospect of Transmeningeal Pharmacotherapy for Intractable Focal Epilepsy

Nutritional supply to the cauda equina in lumbar adhesive arachnoiditis in rats

Postoperative Cerebrospinal Fluid Leakage Associated With Total En Bloc Spondylectomy

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