The denticulate ligament: anatomy and functional significance

Tubbs, R. Shane; Salter, George; Grabb, Paul A.; Oakes, W. Jerry

doi:10.3171/spi.2001.94.2.0271

Cited by 43 publications

(36 citation statements)

References 20 publications

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“…The findings of Tubbs et al [19] are in accordance with ours. Tubbs and coworkers [18] studied the strength of the DL at different spinal levels when forces were applied in different directions (anteroposterior, lateral, caudal, and cephalad).…”

Section: Discussionsupporting

confidence: 92%

The denticulate ligament: anatomical properties, functional and clinical significance

et al. 2012

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Section: Discussionsupporting

confidence: 92%

The denticulate ligament: anatomical properties, functional and clinical significance

et al. 2012

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“…1). We have previously used a similar setup for measuring the forces necessary to avulse the denticulate ligaments (Tubbs et al, 2001). Superior force (N) was exerted on both the left and right optic nerves until failure (disruption of the nerve), and these results were documented.…”

Section: Methodsmentioning

confidence: 99%

Forces necessary for the disruption of the cisternal segments of cranial nerves II through XII

et al. 2005

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Manipulation of the cisternal segment of cranial nerves is often performed by the neurosurgeon. To date, attempts at quantifying the forces necessary to disrupt these nerves in situ, to our knowledge, has not been performed. The present study seeks to further elucidate the forces necessary to disrupt the cranial nerves while within the subarachnoid space. The cisternal segments of cranial nerves II through XII were exposed in six unfixed cadavers, all less than 6 hr postmortem. Forces to failure were then measured. Mean forces necessary to disrupt nerves for left sides in increasing order were found for cranial nerves IX, VII, IV, X, XII, III, VIII, XI, VI, V, and II, respectively. Mean forces for right-sided cranial nerves in increasing order were found for cranial nerves IX, VII, IV, X, XII, VIII, V, VI, XI, III, and II, respectively. Overall, cranial nerves requiring the least amount of force prior to failure included cranial nerves IV, VII, and IX. Those requiring the highest amount of force included cranial nerves II, V, VI, and XI. There was an approximately ten-fold difference between the least and greatest forces required to failure. Cranial nerve III was found to require significantly (P < 0.05) greater forces to failure for right versus left sides. To date, the neurosurgeon has had no experimentally derived data from humans for the in situ forces necessary to disrupt the cisternal segment of cranial nerves II through XII. We found that cranial nerve IX consistently took the least amount of force until its failure and cranial nerve II took the greatest. Other cranial nerves that took relatively small amount of force prior to failure included cranial nerves IV and VII. Although in vivo damage can occur prior to failure of a cranial nerve, our data may serve to provide a rough estimation for the maximal amount of tension that can be applied to a cranial nerve that is manipulated while within its cistern.

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“…Although the fibers of the dentate ligament have longitudinally broad origin on the lateral surface of the spinal cord, the fibers converge at the site of ligament attachment to the dura, creating an open space between the ligament and dura. 10 We estimate that the ventral tumor extended to the dorsal side through this space. An enlarged tumor will deform the spinal cord like a fan because the lateral side of the spinal cord is tethered to the dura by the stretched dentate ligament.…”

Section: Ginkgo Leaf Sign Is Highly Specific To Spinal Meningiomasmentioning

confidence: 99%

Ginkgo leaf sign: a highly predictive imaging feature of spinal meningioma

Yamaguchi

Takeda

Takahashi

et al. 2015

SPI

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OBJECT Spinal meningioma and schwannoma are the most common spinal intradural extramedullary tumors, and the differentiation of these 2 tumors by CT and MRI has been a matter of debate. The purpose of this article is to present a case series of spinal meningiomas showing unique imaging features: a combination of a fan-shaped spinal cord and a streak in the tumor. The authors termed the former imaging feature “ginkgo leaf sign” and evaluated its diagnostic value. METHODS The authors present 7 cases of spinal meningioma having the ginkgo leaf sign. Thirty spinal extramedullary tumors arising lateral or ventrolateral to the spinal cord were studied to evaluate the diagnostic value of the ginkgo leaf sign for spinal meningiomas. Among 30 cases, 12 tumors were spinal meningiomas and 18 tumors from the control group were all schwannomas. RESULTS Seven of the 12 spinal meningiomas were positive for the ginkgo leaf sign. The sign was not present in the control group tumors. The overall ability to use the ginkgo leaf sign to detect meningioma indicated a sensitivity of 58%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 78%. CONCLUSIONS The ginkgo leaf sign is highly specific to spinal meningiomas arising lateral or ventrolateral to the spinal cord. In the present series, the ginkgo leaf sign was perfectly predictive for spinal meningioma.

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The denticulate ligament: anatomy and functional significance

Cited by 43 publications

References 20 publications

The denticulate ligament: anatomical properties, functional and clinical significance

The denticulate ligament: anatomical properties, functional and clinical significance

Forces necessary for the disruption of the cisternal segments of cranial nerves II through XII

Ginkgo leaf sign: a highly predictive imaging feature of spinal meningioma

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