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

硬膜外血补片治疗脑脊液低血容量疗效的形态学研究，特别关注脑脊液漏与硬膜外淋巴系统的关系

• 批准号: 20590173
• 负责人: MASAHIRO Miura
• 金额: $ 3.08万
• 依托单位: Oita University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2008
• 资助国家: 日本
• 起止时间: 2008 至 2010
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-20590173/
• 关键词: 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

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 … More 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

尽管脑脊液低血容量（CFH）通常是由于目前未渗透而引起的，但硬膜外血量（EBP）是一种众所周知的治疗方法CSF泄漏的真实性。 ，尤其是在脊柱硬脑膜上泄漏的血液斑块和最常见的位点位点之间的粘合剂状况，通过使用和流行的猴子……更多的整体含量，对脊柱硬脑膜泄漏用5'-核苷酸酶（5' - nase） - 碱性磷酸酶（ALPase）染色的脊髓硬脑膜的制剂和低温阶段，用于识别和血液毛细管。在扫描电子显微镜（SEM）下，在lant蛋白的条件下观察到EBP的两个样品神经根，流行的淋巴管有许多百叶窗周围的盲叶，并且始终位于流行连接层中的流行连接中，包括丰富的脂肪质量（所谓的脂肪垫）。与背部主部分的一般区域相比，相对松散Dura Mater提出，PLC可以作为CSF附带运输途径起作用的生理学，与SAA区域密切相关，与CSF泄漏的异常加速有关，由于机械膨胀L开发的脂肪垫可能会与血液斑块和血液斑块之间的边界介入相互作用。 Saa dura mater，它可以通过包括淋巴管的软性结缔组织间接地推动异常的dura dura mater来推动saa dura mater的硬脑膜表面

项目成果

Spinal epidural lymphatic systemとCSF側副吸収機序との関係について-脳脊髄液減少症に伴う髄液漏出機序とEBPの有効性に関する形態学的検討も含めて-

关于脊髓硬膜外淋巴系统与脑脊液侧支吸收机制之间的关系 - 包括与脑脊液耗竭相关的脑脊液漏机制的形态学检查以及 EBP 的有效性 -

• 发表时间: 2009
• 作者: 松井浩二;山口真未;青山裕彦;三浦真弘
• 通讯作者: 三浦真弘

脳脊髄液減少症の髄液循環動態について-pre-lymphatic channelの存在とその調節機序について-

关于脑脊液血容量不足时的脑脊液血流动力学 -前淋巴管的存在及其调节机制-

• 发表时间: 2011
• 作者: 鈴木伸一;三浦真弘
• 通讯作者: 三浦真弘

Clinico-anatomical relationship between the peritoneal dissemination and the prelymphatic channel

腹膜播散与淋巴前通道之间的临床解剖关系

• 发表时间: 2010
• 作者: 三浦真弘;米村豊
• 通讯作者: 米村豊

脳脊髄液減?症に対するEpidural blood patchの有効性に関する臨床解剖学的検討-epidural lymphatic systemとの関係を中心にして-

硬膜外血贴治疗脑脊液低血容量有效性的临床解剖学研究——重点关注与硬膜外淋巴系统的关系——

• 发表时间: 2008
• 期刊: Japanese Research Society of Clinical Anatomy. 8巻(1)
• 作者: 三浦真弘;内野哲哉
• 通讯作者: 内野哲哉

ヒトomental milky spotsの形態学的特徴 -播種性転移をともなう形態的変化を含めて-

人网膜乳白色斑点的形态特征 - 包括与播散性转移相关的形态变化 -

• 发表时间: 2010
• 期刊: 日本臨床解剖研究会記録 10
• 作者: 澤田和彦;福西克弘;加島政利;齊藤茂芳;孫学智;坂田ひろみ;洲加本孝幸;青木伊知男;福井義浩;三浦真弘・米村豊・水本良明
• 通讯作者: 三浦真弘・米村豊・水本良明