Neural-Dural Transition at the Thoracic and Lumbar Spinal Nerve Roots: A Histological Study of Human Late-Stage Fetuses.
Neural-Dural Transition at the Thoracic and Lumbar Spinal Nerve Roots: A Histological Study of Human Late-Stage Fetuses.
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DOI：
10.1155/2016/8163519
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发表时间：
2016
影响因子：
--
通讯作者：
Rodríguez-Vázquez JF
中科院分区：
文献类型：
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作者：
Cho KH;Jin ZW;Abe H;Shibata S;Murakami G;Rodríguez-Vázquez JF
硬膜外麻醉已广泛应用于婴儿。然而，关于未成熟的神经-硬脑膜过渡的组织学信息很少。对12例晚期(28-30周)胎儿的神经-硬脑膜过渡进行了组织学研究。脊髓硬膜鞘在标本和节段之间沿不同厚度的神经根延续，而背根神经节鞘通常很薄或不清楚。不成熟的神经-硬脑膜过渡与有效的麻醉有关。神经根后动脉位于背根神经节附近和/或嵌于神经根内，而神经根前动脉与最近的神经根分离。神经根前动脉与硬脑膜鞘无关，但与薄间充质组织相联系。在较大的标本中，神经根动脉的数量趋于减少。同样，较大的上胸段和下腰段标本没有显示动脉。因此，在晚期胎儿中发生了消除神经根动脉以形成单个Adamkiewicz动脉的情况。硬膜外间隙充满静脉，疏松的组织间隙向腹侧延伸至肋间胸膜下组织。因此，婴儿的硬膜外阻滞需要特别注意，尽管不成熟的神经-硬膜外过渡似乎会增加这种效果。
Epidural blocks have been used extensively in infants. However, little histological information is available on the immature neural-dural transition. The neural-dural transition was histologically investigated in 12 late-stage (28–30 weeks) fetuses. The dural sheath of the spinal cord was observed to always continue along the nerve roots with varying thicknesses between specimens and segments, while the dorsal root ganglion sheath was usually very thin or unclear. Immature neural-dural transitions were associated with effective anesthesia. The posterior radicular artery was near the dorsal root ganglion and/or embedded in the nerve root, whereas the anterior radicular artery was separated from the nearest nerve root. The anterior radicular artery was not associated with the dural sheath but with thin mesenchymal tissue. The numbers of radicular arteries tended to become smaller in larger specimens. Likewise, larger specimens of the upper thoracic and lower lumbar segments did not show the artery. Therefore, elimination of the radicular arteries to form a single artery of Adamkiewicz was occurring in late-stage fetuses. The epidural space was filled with veins, and the loose tissue space extended ventrolaterally to the subpleural tissue between the ribs. Consequently, epidural blocks in infants require special attention although immature neural-dural transitions seemed to increase the effect.