Tsutsumi S, Ogino I, Miyajima M, Nakamura M, Yasumoto Y, Arai H, Ito M
From the Department of Neurological Surgery (S.T., Y.Y., M.I.), Juntendo University Urayasu Hospital, Chiba, Japan
Department of Neurological Surgery (I.O., M.M., H.A.), Juntendo University School of Medicine, Tokyo, Japan.
AJNR Am J Neuroradiol. 2014 Sep;35(9):1735-9. doi: 10.3174/ajnr.A4007. Epub 2014 Jun 19.
Studies have suggested that arachnoid villi or granulations found in the walls of the cranial dural sinuses, olfactory mucosa, and cranial nerve sheaths function as outlets for intracranial CSF. However, their role as CSF outlets has not yet been verified. Here we show that arachnoid protrusions and contiguous diploic veins provide an alternative drainage route for intracranial CSF.
Four hundred patients with intact skull, dura mater, and dural sinuses underwent MR imaging to explore arachnoids protruding into the skull and diploic veins. Patients with symptoms of increased intracranial pressure or intracranial hypotension were excluded. For 15 patients undergoing craniotomy, both peripheral and diploic venous blood was collected. Albumin and the CSF-specific biomarkers were measured by enzyme-linked immunosorbent assay.
With MR imaging, arachnoid protrusions into the skull and contiguous diploic veins were consistently identified throughout the cranium with their characteristic appearance depending on the cranial region. In addition, elevated amounts of prostaglandin D synthase and cystatin C were confirmed in diploic veins compared with peripheral venous blood.
Diploic veins are distributed ubiquitously throughout the cranium. A portion of the intracranial CSF may be drained through arachnoid protrusions and contiguous diploic veins.
研究表明，在硬脑膜窦壁、嗅黏膜和脑神经鞘中发现的蛛网膜绒毛或颗粒作为颅内脑脊液的流出通道。然而，它们作为脑脊液流出通道的作用尚未得到证实。在此我们表明，蛛网膜突起和相邻的板障静脉为颅内脑脊液提供了另一种引流途径。
400例颅骨、硬脑膜和硬脑膜窦完整的患者接受了磁共振成像检查，以探索突入颅骨的蛛网膜和板障静脉。排除有颅内压升高或颅内低压症状的患者。对15例接受开颅手术的患者，采集外周血和板障静脉血。通过酶联免疫吸附测定法测量白蛋白和脑脊液特异性生物标志物。
通过磁共振成像，在整个颅骨中始终能识别出突入颅骨的蛛网膜突起和相邻的板障静脉，其特征性外观因颅骨区域而异。此外，与外周静脉血相比，板障静脉中前列腺素D合酶和胱抑素C的含量升高得到证实。
板障静脉普遍分布于整个颅骨。一部分颅内脑脊液可能通过蛛网膜突起和相邻的板障静脉引流。
