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）通常是由赞助的脊髓脑脊液（CSF）泄漏引起的，但非生理泄漏的特定原因远非理解。目前，硬膜外血片（EBP）是众所周知的治疗方法，用于由CFH造成的各种神经系统症状，可归因于CSF泄漏。但是，其形态抑制作用并不是CSF泄漏的真实性质的充分细节。因此，这项研究的主要目的是阐明异常CSF泄漏的形态学机制，特别参考了硬膜外淋巴系统（ELS）和prelymphatic通道（PLC）作为CSF吸收脊髓硬脑膜上的途径。在本研究中，对EBP处理的形态学证据，尤其是血斑和脊柱硬脑膜上CSF泄漏部位之间的粘合剂条件，通过使用猴子的硬膜外注射来研究电晶状体和酶 - 历史上的电酶 - 历史。用5'-核苷酸酶（5'-Nase） - 碱性磷酸酶（ALPase）对脊髓硬脑膜的整体制剂和低温恒温片进行双染色，分别用于鉴定淋巴和血毛细血管vissels。在脊髓硬脑膜中分析了发达的硬膜外淋巴网络。在从甲米格纳（Cisterna Magna）注入血液进入硬膜外空间后，在光学显微镜中观察到带有血斑的脊柱硬脑膜。在扫描电子显微镜（SEM）下，在纤维蛋白密封剂位点的条件下观察到EBP后两个样品的一部分。 5'-Nase阳性淋巴网络和脊髓蛛网膜颗粒（SAG）局部出现在颈脊髓神经根周围的亚蛛网膜下角（SAA）中。在背神经根的SAA区域中，硬膜外淋巴视频周围有许多盲末端，并且始终位于硬膜外结缔组织层中，包括丰富的脂肪质量（所谓的脂肪垫）。在SEM观察中，与背侧主部分的一般区域相比，SAA区域中具有滚动布置的硬膜组分胶原纤维相对较宽。这些发现可能会推断，与其他硬脑膜的结构相比，脊柱神经根基底性硬膜结构中的CSF生理滥用能力更高。硬脑膜已被提议，PLC可以作为SAA地区的CSF侧支传输途径的身体工作，并且与CSF泄漏的异常加速密切相关，这是由于脊柱硬脑膜囊中的机械扩张或缺陷，而发育良好的脂肪垫可能会与良好的脂肪垫与血液贴片之间的边界表面交织在一起。因此，可能很难通过EBP直接密封Saa Dura Mater的硬脑膜表面。然而，可以预期的EBP处理是通过通过软性连接的组织（包括毛发性脑内淋巴管的软组织）间接推动异常扩张的硬脑膜损耗，从而可以预期EBP处理。较少的

项目成果

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

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

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

Use of Imaging Agent to Determine Postoperative Indowelling Epidural Catheter Position.

使用显像剂确定术后留置硬膜外导管位置。

• 发表时间: 2010
• 期刊: The Korean Journal of Pain 23巻
• 作者: Uchino T;Hagiwara S;Iwasaka H;Kubo K;Takatani J;M Miura;Noguchi T
• 通讯作者: Noguchi T