Reina M A, López A, De Andrés J A
Servicio de Anestesiología y Reanimación, Hospital de Móstoles, Madrid.
Rev Esp Anestesiol Reanim. 2004 May;51(5):240-6.
Although the mechanism by which cranial subdural hematomas form is known, the formation of spinal subdural hematomas is less clearly defined. The aim of this study was to identify vessels that can be found in the dural sac and whose rupture might lead to the formation of spinal subdural hematomas.
The dura mater, subdural space, and the arachnoid mater were studied in samples of dural sac taken from the eleventh thoracic vertebra to the fifth lumbar vertebra. The samples were taken from 3 fresh cadavers. Some were fixed in glutaraldehyde, dehydrated, and metallized with gold for scanning electron microscopy. Others were fixed in glutaraldehyde, treated with osmium tetroxide, and embedded in an epoxy resin for observation under a transmission electron microscope.
Small hematomas--some on the internal surface of the dura mater and others surrounding nerve roots--were found within a thin, translucent arachnoid mater. Vessels measuring up to 100 microm were found within the dura mater, between its inner and outer laminae. Venules and capillaries were observed in the subdural space and in the arachnoid mater.
Vessels are present between the laminae of the dura mater, in the subdural space, the arachnoid mater, and in spinal nerve roots. The rupture of these vessels could account for the formation of spinal subdural hematomas.
虽然颅骨硬膜下血肿形成的机制已为人所知，但脊髓硬膜下血肿的形成尚不清楚。本研究的目的是确定在硬膜囊内可发现的、其破裂可能导致脊髓硬膜下血肿形成的血管。
对取自第11胸椎至第5腰椎的硬膜囊样本中的硬脑膜、硬膜下间隙和蛛网膜进行研究。样本取自3具新鲜尸体。一些样本用戊二醛固定，脱水，用金进行金属化处理以用于扫描电子显微镜观察。其他样本用戊二醛固定，用四氧化锇处理，然后嵌入环氧树脂中以用于透射电子显微镜观察。
在一层薄的、半透明的蛛网膜内发现了小血肿——一些位于硬脑膜内表面，另一些围绕神经根。在硬脑膜内、外层之间发现了直径达100微米的血管。在硬膜下间隙和蛛网膜内观察到了小静脉和毛细血管。
血管存在于硬脑膜层之间、硬膜下间隙、蛛网膜内以及脊髓神经根内。这些血管的破裂可能是脊髓硬膜下血肿形成的原因。
