Radiology, Neurology, New York University School of Medicine, New York, New York, USA
Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
J Neurointerv Surg. 2021 May;13(5):471-477. doi: 10.1136/neurintsurg-2020-016798. Epub 2021 Feb 25.
Adoption of middle meningeal artery embolization in the management of chronic subdural hematomas has led to a renewed interest in dural vascular anatomy. The readily identifiable major dural arteries and potential hazards associated with their embolization are well described. Less emphasized are several levels of intrinsic dural angioarchitecture, despite their more direct relationship to dural based diseases, such as subdural hematoma and dural fistula. Fortunately, microvascular aspects of dural anatomy, previously limited to ex vivo investigations, are becoming increasingly accessible to in vivo visualization, setting the stage for synthesis of the old and the new, and providing a rationale for the endovascular approach to subdural collections in particular. In contrast with traditional anatomical didactics, where descriptions advance from larger trunks to smaller pedicles, we present a strategic approach that proceeds from a fundamental understanding of the dural microvasculature and its relationship to larger vessels.
慢性硬脑膜下血肿的治疗中采用中间脑膜动脉栓塞术，这使得人们对硬脑膜血管解剖结构重新产生了兴趣。易于识别的主要硬脑膜动脉及其栓塞相关的潜在危险已得到充分描述。尽管硬脑膜固有血管结构与硬脑膜相关疾病（如硬脑膜下血肿和硬脑膜动静脉瘘）有更直接的关系，但人们对其重视程度较低。幸运的是，硬脑膜解剖的微血管方面，以前仅限于离体研究，现在越来越容易在体内可视化，为新旧知识的综合提供了条件，并为硬脑膜下血肿的血管内治疗方法提供了理论依据。与传统的解剖学教学法不同，传统的解剖学教学法是从较大的干到较小的分支进行描述，我们提出了一种从理解硬脑膜微血管及其与较大血管的关系出发的策略性方法。
