Skip to main content

Advertisement

SpringerLink
Log in

Anatomy and development of the meninges: implications for subdural collections and CSF circulation

  • Theoretical Considerations
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

The dura is traditionally viewed as a supportive fibrous covering of the brain containing the dural venous sinuses but otherwise devoid of vessels and lacking any specific function. However, review of the embryology and anatomy reveals the dura to be a complex, vascularized and innervated structure, not a simple fibrous covering. The dura contains an inner vascular plexus that is larger in the infant than in the adult, and this plexus likely plays a role in CSF absorption. This role could be particularly important in the infant whose arachnoid granulations are not completely developed. Although subdural hemorrhage is frequently traumatic, there are nontraumatic conditions associated with subdural hemorrhage, and the inner dural plexus is a likely source of bleeding in these nontraumatic circumstances. This review outlines the development and age-specific vascularity of the dura and offers an alternative perspective on the role of the dura in homeostasis of the central nervous system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Ravid S, Maytal J (2003) External hydrocephalus: a probable cause for subdural hematoma in infancy. Pediatr Neurol 28:139–141

    Article  PubMed  Google Scholar 

  2. Barnes PD, Krasnokutsky M (2007) Imaging of the central nervous system in suspected or alleged nonaccidental injury, including the mimics. Top Magn Reson Imaging 18:53–74

    Article  PubMed  Google Scholar 

  3. Hellbusch LC (2007) Benign extracerebral fluid collections in infancy: clinical presentation and long-term follow-up. J Neurosurg 107:119–125

    PubMed  Google Scholar 

  4. McNeely PD, Atkinson JD, Saigal G et al (2006) Subdural hematoma in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse. AJNR 27:1725–1728

    PubMed  CAS  Google Scholar 

  5. Amodio J, Spektor V, Pramanik B et al (2005) Spontaneous development of bilateral subdural hematomas in an infant with benign infantile hydrocephalus: color Doppler assessment of vessels traversing extra-axial spaces. Pediatr Radiol 35:1113–1117

    Article  PubMed  Google Scholar 

  6. Strauss KA, Puffenberger EG, Robinson DL et al (2003) Type I glutaric aciduria, part 1: natural history of 77 patients. Am J Med Genet C Semin Med Genet 121C:38–52

    Article  PubMed  Google Scholar 

  7. Bishop FS, Liu JK, McCall TD et al (2007) Glutaric aciduria type 1 presenting as bilateral subdural hematomas mimicking nonaccidental trauma: case report and review of the literature. J Neurosurg 106(3 Suppl):222–226

    PubMed  Google Scholar 

  8. Haritanti A, Karacostas D, Drevelengas A et al (2008) Spontaneous intracranial hypotension: clinical and neuroimaging findings in six cases with literature review. Eur J Radiol. doi:10.1016/j.ejrad.2007.10.013

  9. Lai TH, Fuh JL, Lirng JF et al (2007) Subdural haematoma in patients with spontaneous intracranial hypotension. Cephalalgia 27:133–138

    Article  PubMed  CAS  Google Scholar 

  10. Sirotnak A (2006) Medical disorders that mimic abusive head trauma. In: Frasier L, Farley K, Alexander R et al (eds) Abusive head trauma in infants and children. GW Medical Publishing, St. Louis, MO, pp 191–226

    Google Scholar 

  11. Hymel KP, Jenny C, Block RW (2002) Intracranial hemorrhage and rebleeding in suspected victims of abusive head trauma: addressing the forensic controversies. Child Maltreat 7:329–348

    Article  PubMed  Google Scholar 

  12. Kleinman P, Barnes P (1998) Head trauma. In: Kleinman P (ed) Diagnostic imaging of child abuse. Mosby Year Book, New York, pp 285–342

    Google Scholar 

  13. Haines DE, Harkey HL, al-Mefty O (1993) The “subdural” space: a new look at an outdated concept. Neurosurgery 32:111–120

    Article  PubMed  CAS  Google Scholar 

  14. Vandenabeele F, Creemers J, Lambrichts I (1996) Ultrastructure of the human spinal arachnoid mater and dura mater. J Anat 189:417–430

    PubMed  Google Scholar 

  15. Nabeshima S, Reese TS, Landis DM et al (1975) Junctions in the meninges and marginal glia. J Comp Neurol 164:127–169

    Article  PubMed  CAS  Google Scholar 

  16. Frederickson RG (1991) The subdural space interpreted as a cellular layer of meninges. Anat Rec 230:38–51

    Article  PubMed  CAS  Google Scholar 

  17. Rascol MM, Izard JY (1976) The subdural neurothelium of the cranial meninges in man. Anat Rec 186:429–436

    Article  PubMed  CAS  Google Scholar 

  18. Schachenmayr W, Friede RL (1978) The origin of subdural neomembranes I. Fine structure of the dura-arachnoid interface in man. Am J Pathol 92:53–68

    PubMed  CAS  Google Scholar 

  19. Orlin JR, Osen KK, Hovig T (1991) Subdural compartment in pig: a morphologic study with blood and horseradish peroxidase infused subdurally. Anat Rec 230:22–37

    Article  PubMed  CAS  Google Scholar 

  20. Gagan JR, Tholpady SS, Ogle RC (2007) Cellular dynamics and tissue interactions of the dura mater during head development. Birth Defects Res C Embryo Today 81:297–304

    Article  PubMed  CAS  Google Scholar 

  21. Angelov DN, Vasilev VA (1989) Morphogenesis of rat cranial meninges: a light and electron-microscopic study. Cell Tissue Res 257:207–216

    Article  PubMed  CAS  Google Scholar 

  22. Hamilton WJ, Boyd JD, Mossman HW (1957) Human embryology. Williams and Wilkins, Baltimore, MD, pp 342–349

    Google Scholar 

  23. Greenwald JA, Mehrara BJ, Spector JA et al (2000) Immature versus mature dura mater: II. Differential expression of genes important to calvarial reossification. Plast Reconstr Surg 106:630–638

    Article  PubMed  CAS  Google Scholar 

  24. Streeter GL (1915) The development of the venous sinuses of the dura mater in the human embryo. Am J Anat 18(2):145–178. doi:10.1002/aja.1000180202

    Article  Google Scholar 

  25. Padget DH (1957) The development of the cranial venous system in man from the viewpoint of comparative anatomy. Contrib Embryol 36:79–140

    Google Scholar 

  26. Capra NF, Anderson KV (1984) Anatomy of the cerebral venous system. In: Kapp JP, Schmidek HH (eds) The cerebral venous system and its disorders. Grune and Stratton, Orlando, FL, pp 1–36

    Google Scholar 

  27. O’Connell JE (1934) Some observations on the cerebral veins. Brain 57:484–503

    Article  Google Scholar 

  28. Han H, Tao W, Zhang M (2007) The dural entrance of cerebral bridging veins into the superior sagittal sinus: an anatomical comparison between cadavers and digital subtraction angiography. Neuroradiology 49:169–175

    Article  PubMed  Google Scholar 

  29. Lowenheilm P (1974) Dynamic properties of the parasagittal bridging veins. Z Rechtsmedizin 74:55–62

    Article  Google Scholar 

  30. Lee M-C, Haut RC (1989) Insensitivity of tensile failure properties of human bridging veins to strain rate: implications in biomechanics of subdural hematoma. J Biomechanics 22:537–542

    Article  CAS  Google Scholar 

  31. Christensen E (1944) Studies on chronic subdural hematoma. Acta Psychiatr Scand 19:69–148

    Article  Google Scholar 

  32. Kerber CW, Newton TH (1973) The macro and microvasculature of the dura mater. Neuroradiology 6:175–179

    Article  PubMed  CAS  Google Scholar 

  33. Rowbotham GF, Little E (1965) Circulations of the cerebral hemispheres. Br J Surg 52:8–21

    Article  PubMed  CAS  Google Scholar 

  34. Roland J, Bernard C, Bracard S et al (1987) Microvascularization of the intracranial dura mater. Surg Radiol Anat 9:43–49

    Article  PubMed  CAS  Google Scholar 

  35. Key A, Retzius G (1875–1876) Studien in der Anatomie des Nervensystems und des Bindegewebes. Samson and Waller, Stockholm, Sweden

    Google Scholar 

  36. Hannah JA (1936) The aetiology of subdural hematoma: an anatomical and pathological study. J Nerve Ment Dis 84:169–186

    Google Scholar 

  37. Fox RJ, Walji AH, Mielke B et al (1996) Anatomic details of intradural channels in the parasagittal dura: a possible pathway for flow of cerebrospinal fluid. Neurosurgery 39:84–90

    Article  PubMed  CAS  Google Scholar 

  38. Bolay H, Reuter U, Dunn AK et al (2002) Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model. Nat Med 8:136–142

    Article  PubMed  CAS  Google Scholar 

  39. Markowitz S, Saito K, Moskowitz MA (1987) Neurogenically mediated leakage of plasma protein occurs from blood vessels in dura mater but not brain. J Neurosci 7:4129–4136

    PubMed  CAS  Google Scholar 

  40. Penfield W, McNaughton M (1940) Dural headache and innervation of the dura mater. Arch Neurol Psychiatry 44:43–75

    Google Scholar 

  41. Feindel W, Penfield W, McNaughton F (1960) The tentorial nerves and localization of intracranial pain in man. Neurology 10:555–563

    PubMed  CAS  Google Scholar 

  42. Kaplan HA, Browder J, Krieger AJ (1975) Venous channels within the intracranial dural partitions. Radiology 115:641–645

    PubMed  CAS  Google Scholar 

  43. Gooding CA, Price DC, Newton TH (1972) Experimental studies of falx and tentorial opacification during cerebral angiography. Radiology 102:77–82

    PubMed  CAS  Google Scholar 

  44. Browder J, Kaplan HA, Krieger AJ (1975) Venous lakes in the suboccipital dura mater and falx cerebelli of infants: surgical significance. Surg Neurol 4:53–55

    PubMed  CAS  Google Scholar 

  45. Le Gros Clark WE (1920) On the Pacchionian bodies. J Anat 55(Pt 1):40–48

    PubMed  Google Scholar 

  46. Grzybowski DM, Herderick EE, Kapoor KG et al (2007) Human arachnoid granulations part I: a technique for quantifying area and distribution on the superior surface of the cerebral cortex. Cerebrospinal Fluid Res 4:6

    Article  PubMed  Google Scholar 

  47. Zenker W, Bankoul S, Braun JS (1994) Morphological indications for considerable diffuse reabsorption of cerebrospinal fluid in spinal meninges, particularly in the areas of meningeal funnels: an electron microscopical study including tracing experiments in rats. Anat Embyol (Berl) 189:243–258

    CAS  Google Scholar 

  48. Johnston M, Armstrong D, Koh L (2007) Possible role of the cavernous sinus veins in cerebrospinal fluid absorption. Cerebrospinal Fluid Res 4:3

    Article  PubMed  Google Scholar 

  49. Papaiconomou C, Zakharov A, Azizi N et al (2004) Reassessment of the pathways responsible for cerebrospinal fluid absorption in the neonate. Childs Nerv Syst 20:29–36

    Article  PubMed  CAS  Google Scholar 

  50. De La Motte DJ (1978) Removal of horseradish peroxidase and fluorescein-labelled dextran from CSF spaces of rabbit optic nerve: a light and electron microscope study. Exp Eye Res 27:585–594

    Article  PubMed  Google Scholar 

  51. Kristof RA, Grimm JM, Stoffel-Wagner B (2008) Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma. J Neurosurg 108:275–280

    Article  PubMed  CAS  Google Scholar 

  52. Zouros A, Bhargava R, Hoskinson M et al (2004) Further characterization of traumatic subdural collections of infancy: report of five cases. J Neurosurg 100(5 Suppl Pediatrics):512–518

    PubMed  Google Scholar 

  53. Vinchon M, Noule N, Tchofo PJ et al (2004) Imaging of head injuries in infants: temporal correlates and forensic implications for the diagnosis of child abuse. J Neurosurg. 101(1 Suppl):44–52

    PubMed  Google Scholar 

  54. Geddes JF, Hackshaw AK, Vowles GH et al (2001) Neuropathology of inflicted head injury in children. I. Patterns of brain damage. Brain 124(Pt7):1290–1298

    Article  PubMed  CAS  Google Scholar 

  55. Vinchon M, Noizet O, Defoort-Dhellemmes S (2002) Infantile subdural hematomas due to traffic accidents. Pediatr Neurosurg 37:245–253

    Article  PubMed  Google Scholar 

  56. Macdonald RL, Hoffman HJ, Kestle JR et al (1994) Needle aspiration of acute subdural hematomas in infancy. Pediatr Neurosurg 20:73–76

    Article  PubMed  CAS  Google Scholar 

  57. Ikeda A, Sato O, Tsuqane R et al (1987) Infantile acute subdural hematoma. Childs Nerv Syst 3:19–22

    Article  PubMed  CAS  Google Scholar 

  58. Lonergan GJ, Baker AM, Morey MK et al (2003) From the archives of the AFIP. Child abuse: radiologic-pathologic correlation. Radiographics 23:811–845

    Article  PubMed  Google Scholar 

  59. Yamashima T, Friede RL (1984) Why do bridging veins rupture into the virtual subdural space? J Neurol Neurosurg Psychiatry 47:121–127

    Article  PubMed  CAS  Google Scholar 

  60. Jaspan T (2008) Current controversies in the interpretation of non-accidental injury. Pediatr Radiol 38(Suppl 3):S378–S387

    Article  PubMed  Google Scholar 

  61. Smith C, Bell J (2008) Shaken baby syndrome: evidence and experts. Dev Med Child Neurol 50:6–7

    Article  PubMed  CAS  Google Scholar 

  62. Craig W (1938) Intracranial haemorrhage in the newborn—a study of diagnosis and differential diagnosis based on pathological and clinical findings in 126 cases. Arch Dis Child 13:89–124

    Article  Google Scholar 

  63. Cushing H, Goodrich JT (2000) Reprint of “Concerning Surgical Intervention for the Intracranial Hemorrhages of the New-born” by Harvey Cushing, MD, 1905. Childs Nerv Syst 16:484–492

    Article  PubMed  CAS  Google Scholar 

  64. Maxeiner H (1997) Detection of ruptured cerebral bridging veins at autopsy. Forensic Sci Int 89:103–110

    Article  PubMed  CAS  Google Scholar 

  65. Maxeiner H, Spies C, Irnich B et al (1999) Rupture of several parasagittal bridging veins without subdural bleeding. J Trauma 47:606–610

    Article  PubMed  CAS  Google Scholar 

  66. Depreitere B, Van Lierde C, Sloten JV et al (2006) Mechanics of acute subdural hematomas resulting from bridging vein rupture. J Neurosurg 104:950–956

    Article  PubMed  Google Scholar 

  67. Vignes JR, Dagain A, Guerin J et al (2007) A hypothesis of cerebral venous system regulation based on a study of the junction between the cortical bridging veins and the superior sagittal sinus. Laboratory investigation. J Neurosurg 107:1205–1210

    Article  PubMed  Google Scholar 

  68. Dagain A, Vignes JR, Dulou R et al (2008) Junction between the great cerebral vein an the straight sinus: an anatomical, immunohistochemical, and ultrastructural study on 25 human brain cadaveric dissections. Clin Anat 21:389–397

    Article  PubMed  CAS  Google Scholar 

  69. Si Z, Luan L, Kong D et al (2008) MRI-based investigation on outflow segment of cerebral venous system under increased ICP condition. Eur J Med Res 13:121–126

    PubMed  CAS  Google Scholar 

  70. Kibayashi K, Shojo H, Sumida T (2005) Dural hemorrhage of the tentorium on postmortem cranial computed tomographic scans in children. Forensic Sci Int 154:206–209

    Article  PubMed  Google Scholar 

  71. Tubbs RS, Loukas M, Louis RG et al (2007) Anatomy of the falcine venous plexus. J Neurosurg 107:155–157

    Article  PubMed  Google Scholar 

  72. Geddes JF, Tasker RC, Hackshaw AK (2003) Dural haemorrhage in non-traumatic infant deaths: does it explain the bleeding in ‘shaken baby syndrome’? Neuropathol Appl Neurobiol 29:14–22

    Article  PubMed  CAS  Google Scholar 

  73. Rooks VJ, Eaton JP, Ruess L et al (2008) Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants. AJNR 29:1082–1089

    PubMed  CAS  Google Scholar 

  74. Looney CB, Smith JK, Merck LH et al (2007) Intracranial hemorrhage in asymptomatic neonates: prevalence on MR images and relationship to obstetric and neonatal risk factors. Radiology 242:535–541

    Article  PubMed  Google Scholar 

  75. Whitby EH, Griffiths PD, Rutter S et al (2004) Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet 363:846–851

    Article  PubMed  CAS  Google Scholar 

  76. Chamnanvanakij S, Rollins N, Perlman JM (2002) Subdural hematoma in term infants. Pediatr Neurol 26:301–304

    Article  PubMed  Google Scholar 

  77. Brodbelt A, Stoodley M (2007) CSF pathways: a review. Br J Neurosurg 21:510–520

    Article  PubMed  CAS  Google Scholar 

  78. Johanson CE, Duncan JA 3rd, Klinge PM et al (2008) Multiplicity of cerebrospinal fluid functions: new challenges in health and disease. Cerebrospinal Fluid Res 5:10

    Article  PubMed  CAS  Google Scholar 

  79. Savoiardo M, Minati L, Farina L et al (2007) Spontaneous intracranial hypotension with deep brain swelling. Brain 130(Pt 7):1884–1893

    Article  PubMed  Google Scholar 

  80. Kashmere JL, Jacka MJ, Emery D et al (2004) Reversible coma: a rare presentation of spontaneous intracranial hypotension. Can J Neurol Sci 31:565–568

    PubMed  Google Scholar 

  81. Agrawal D, Durity FA (2006) Seizure as a manifestation of intracranial hypotension in a shunted patient. Pediatr Neurosurg 42:165–167

    Article  PubMed  Google Scholar 

  82. Couch JR (2008) Spontaneous intracranial hypotension: the syndrome and its complications. Curr Treat Options Neurol 10:3–11

    Article  PubMed  Google Scholar 

  83. Schievink WI (2006) Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 295:2286–2296

    Article  PubMed  CAS  Google Scholar 

  84. Schievink WI (2000) Spontaneous spinal cerebrospinal fluid leaks: a review. Neurosurg Focus 9:e8

    Article  PubMed  CAS  Google Scholar 

  85. Cheuret E, Edouard T, Mejdoubi M et al (2008) Intracranial hypotension in a girl with Marfan syndrome: case report and review of the literature. Childs Nerv Syst 24:509–513

    Article  PubMed  CAS  Google Scholar 

  86. Rosser T, Finkel J, Vezina G et al (2005) Postural headache in a child with Marfan syndrome: case report and review of the literature. J Child Neurol 20:153–155

    Article  PubMed  Google Scholar 

  87. Puget S, Kondageski C, Wray A et al (2007) Chiari-like tonsillar herniation associated with intracranial hypotension in Marfan syndrome. Case report. J Neurosurg 106(1 Suppl):48–52

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Penn State Hershey Medical Center, 30 Hope Drive, Suite 1800, P.O. Box 859, Hershey, PA, 17033-0859, USA

    Julie Mack

  2. Department of Neuropathology, John Radcliffe Hospital, Oxford, UK

    Waney Squier

  3. Department of Pathology and Laboratory Medicine, Lancaster General Hospital, Lancaster, PA, USA

    James T. Eastman

Authors
  1. Julie Mack
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Waney Squier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James T. Eastman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie Mack.

Additional information

Editor’s note: see related articles in this issue: doi:10.1007/s00247-008-1137-x (Commentary) and doi:10.1007/s00247-008-1144-y (Editorial)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mack, J., Squier, W. & Eastman, J.T. Anatomy and development of the meninges: implications for subdural collections and CSF circulation. Pediatr Radiol 39, 200–210 (2009). https://doi.org/10.1007/s00247-008-1084-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-008-1084-6

Keywords

Search

Navigation