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Cheshire EC, Harris NC, Malcomson RDG, Amoroso JM, Moreton JE, Biggs MJP. Macroscopic and histological examination of human bridging veins. Forensic Sci Int 2024; 361:112080. [PMID: 38838611 DOI: 10.1016/j.forsciint.2024.112080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
In infantile abusive head injury (AHT), subdural haemorrhage (SDH) is commonly held to result from traumatic damage to bridging veins traversing from the surface of the brain to the dura and dural venous sinuses. However, there are limited published radiological or autopsy demonstrations of ruptured bridging veins and several authors also assert that bridging veins are too large to rupture due to the forces associated with AHT. There have been several studies on the size, locations and numbers of adult bridging veins and there is one small study of infant bridging veins. However, there are no microscopic studies of infant bridging veins and only a select few ultrastructural investigations of adult bridging veins. Hitherto, it has been assumed that bridging veins from infants and younger children will display the same anatomical characteristics as those in adulthood. At 19 neonatal, infant and young child post-mortem examinations, we macroscopically examined and sampled bridging veins for microscopy. We compared the histology of those samples with bridging veins from an older child and two adults. We demonstrate that adult bridging veins are usually surrounded by supportive meningeal tissue that appears to be lacking or minimally present around the bridging veins of younger children. Neonatal, infant and young children's veins had a free 'bridging' section. Neonatal and infant bridging veins had smaller diameter ranges and thinner walls (some only 5-7 µm) than those seen in older children and adults. Bridging vein walls contained both fine strands of elastic fibers and a more pronounced elastic lamina. The presence of an elastic lamina occurred more frequently in the older age groups These anatomical differences between the veins of adults and young children may help to explain apparent increased vulnerability of neonatal/infant bridging veins to the forces associated with a shaking-type traumatic event.
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Affiliation(s)
- Emma C Cheshire
- University of Leicester, East Midlands Forensic Pathology Unit, Robert Kilpatrick Building, Level 3 Leicester Royal Infirmary, Leicester LE2 7LX, UK.
| | - Neil C Harris
- University of Leicester, East Midlands Forensic Pathology Unit, Robert Kilpatrick Building, Level 3 Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - Roger D G Malcomson
- Histopathology Department, Leicester Royal Infirmary, Infirmary Close, Leicester LE1 5WW, UK
| | - Jasmin M Amoroso
- University of Leicester, East Midlands Forensic Pathology Unit, Robert Kilpatrick Building, Level 3 Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - Janine E Moreton
- University of Leicester, Histology Facility, Core Biotechnology Services, Robert Kilpatrick Building, Level 1 Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - Mike J P Biggs
- University of Leicester, East Midlands Forensic Pathology Unit, Robert Kilpatrick Building, Level 3 Leicester Royal Infirmary, Leicester LE2 7LX, UK
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Parker S, Cramberg M, Scott A, Sopko S, Swords A, Taylor E, Young BA. On the spinal venous sinus of Alligator mississippiensis. Anat Rec (Hoboken) 2024. [PMID: 38323749 DOI: 10.1002/ar.25403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/08/2024]
Abstract
The epidural space of the American alligator (Alligator mississippiensis) is largely filled by a continuous venous sinus. This venous sinus extends throughout the trunk and tail of the alligator, and is continuous with the dural sinuses surrounding the brain. Segmental spinal veins (sl) link the spinal venous sinus (vs) to the somatic and visceral venous drainage. Some of these sl, like the caudal head vein along the occipital plate of the skull, are enlarged, suggesting more functional linkage. No evidence of venous valves or external venous sphincters was found associated with the vs; the relative scarcity of smooth muscle in the venous wall of the sinus suggests limited physiological regulation. The proatlas (pr), which develops between the occipital plate and C1 in crocodylians, is shaped like a neural arch and is fused to the dorsal surface of the vs. The present study suggests that the pr may function to propel venous blood around the brain and spinal cord. The vs effectively encloses the spinal dura, creating a tube-within-a-tube system with the (smaller volume) spinal cerebrospinal fluid (CSF). Changes in venous blood pressure, as are likely during locomotion, would impact dural compliance and CSF pressure waves propagating along the spinal cord.
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Affiliation(s)
- Seth Parker
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
| | - Michael Cramberg
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
| | - Anchal Scott
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
| | - Stephanie Sopko
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
| | - Annelise Swords
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
| | - Ethan Taylor
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
| | - Bruce A Young
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
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Zadka Y, Rosenthal G, Doron O, Barnea O. Limitation of cerebral blood flow by increased venous outflow resistance in elevated ICP. J Appl Physiol (1985) 2024; 136:224-232. [PMID: 38059286 DOI: 10.1152/japplphysiol.00477.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/13/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
Extensive investigation and modeling efforts have been dedicated to cerebral pressure autoregulation, which is primarily regulated by the ability of the cerebral arterioles to change their resistance and modulate cerebral blood flow (CBF). However, the mechanisms by which elevated intracranial pressure (ICP) leads to increased resistance to venous outflow have received less attention. We modified our previously described model of intracranial fluid interactions with a newly developed model of a partially collapsed blood vessel, which we termed the "flow control zone" (FCZ). We sought to determine the degree to which ICP elevation causing venous compression at the FCZ becomes the main parameter limiting CBF. The FCZ component was designed using nonlinear functions representing resistance as a function of cross-sectional area and the pressure-volume relations of the vessel wall. We used our previously described swine model of cerebral edema with graduated elevation of ICP to calculate venous outflow resistance and a newly defined parameter, the cerebral resistance index (CRI), which is the ratio between venous outflow resistance and cerebrovascular resistance. Model simulations of cerebral edema and increased ICP led to increased venous outflow resistance. There was a close similarity between model predictions of venous outflow resistance and experimental results in the swine model (cross-correlation coefficient of 0.97, a mean squared error of 0.087, and a mean absolute error of 0.15). CRI was strongly correlated to ICP in the swine model (r2 = 0.77, P = 0.00012, 95% confidence interval [0.15, 0.45]). A CRI value of 0.5 was associated with ICP values above clinically significant thresholds (24 mmHg) in the swine model and a diminished capacity of changes in arteriolar resistance to influence flow in the mathematical model. Our results demonstrate the importance of venous compression at the FCZ in determining CBF when ICP is elevated. The cerebral resistance index may provide an indication of when compression of venous outflow becomes the dominant factor in limiting CBF following brain injury.NEW & NOTEWORTHY The goal of this study was to investigate the effects of venous compression caused by elevated intracranial pressure (ICP) due to cerebral edema, validated through animal experiments. The flow control zone model highlights the impact of cerebral venous compression on cerebral blood flow (CBF) during elevated ICP. The cerebral venous outflow resistance-to-cerebrovascular resistance ratio may indicate when venous outflow compression becomes the dominant factor limiting CBF. CBF regulation descriptions should consider how arterial or venous factors may predominantly influence flow in different clinical scenarios.
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Affiliation(s)
- Yuliya Zadka
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Guy Rosenthal
- Department of Neurosurgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Omer Doron
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Ofer Barnea
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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Bateman GA, Bateman AR, Lechner-Scott J. Dilatation of the bridging cerebral veins in multiple sclerosis correlates with fatigue and suggests an increase in pressure. Mult Scler Relat Disord 2023; 76:104843. [PMID: 37356258 DOI: 10.1016/j.msard.2023.104843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/26/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND There is a significant increase in the parenchymal microvessel blood volume in the earliest forms of multiple sclerosis (MS) which may be due to venular dilatation. Increased cortical venous pressure could account for this finding. Venous pressure is also implicated in the physiology of fatigue. The purpose of this study is to discover if there is dilatation of the veins within the subarachnoid space in multiple sclerosis and to estimate the pressures required to maintain any enlargement found. These findings will be correlated with the fatigue symptoms found in MS. METHODS 103 patients with MS were compared with a control group of 50 patients. Post contrast 3DT1 images were used. The cross-sectional area of the bridging cortical veins and the vein of Galen were measured. RESULTS In MS, the superficial territory cortical veins were 29% larger and the veins of Galen were 25% larger than the controls. CONCLUSION There is evidence of a significant increase in the bridging vein transmural pressure in MS, estimated to be approximately 6.5 mmHg in the superficial cortical veins. MS patients with significant fatigue have larger cortical veins than those who are not significantly fatigued.
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Affiliation(s)
- Grant A Bateman
- Department of Medical Imaging, John Hunter Hospital, Newcastle, NSW, Australia; Newcastle University Faculty of Health, Callaghan Campus, Newcastle, NSW, Australia.
| | - Alexander R Bateman
- School of Mechanical Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Jeannette Lechner-Scott
- Newcastle University Faculty of Health, Callaghan Campus, Newcastle, NSW, Australia; Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
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Park JS, Sin EG. Clinical Importance of Prophylactic Ligation of the Bridging Vein in Acute Subdural Hematoma: A Case Report. Korean J Neurotrauma 2023; 19:103-108. [PMID: 37051041 PMCID: PMC10083443 DOI: 10.13004/kjnt.2023.19.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/02/2022] [Accepted: 10/17/2022] [Indexed: 02/25/2023] Open
Abstract
Acute subdural hematoma (ASDH) induced by a bridging vein (BV) rupture is considered a catastrophic head injury, especially in the elderly. Epidemiological studies have shown a much higher incidence rate of BV-induced ASDH in the elderly compared to younger adults, along with elevated morbidity and mortality, and poor outcomes. Brain atrophy can be a risk factor contributing to the increased risk of ASDH in elderly trauma patients. Considering this, prophylactic ligation of the impending breakage in the BV may reduce the risk of rebleeding and treat the ASDH. Here, we report a relevant case.
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Affiliation(s)
- Jun Seok Park
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Eui Gyu Sin
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
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Miyake S, Nakai Y, Suenaga J, Akimoto T, Uemura K, Funakoshi K, Yamamoto T. Characteristic of Non–Sinus-Type Parasagittal Dural Arteriovenous Fistulas: Clinical and Cadaveric Experiences. NEUROSURGERY OPEN 2022. [DOI: 10.1227/neuopn.0000000000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bateman GA, Bateman AR, Subramanian GM. Dilatation of the bridging cerebral cortical veins in childhood hydrocephalus suggests a malfunction of venous impedance pumping. Sci Rep 2022; 12:13045. [PMID: 35906407 PMCID: PMC9338310 DOI: 10.1038/s41598-022-17465-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/26/2022] [Indexed: 12/20/2022] Open
Abstract
Dogs with a naturally occurring form of hydrocephalus have an elevated transmural venous pressure leading to cortical vein dilatation. The purpose of this study is to discover if there is vein dilatation in childhood hydrocephalus and to estimate the pressure required to maintain any enlargement found. Children with hydrocephalus between the ages of 4 and 15 years were compared with a control group. Magnetic resonance venography (MRV) and flow quantification were performed. The arterial inflow, sagittal sinus and straight sinus venous outflow were measured and the outflow percentages compared to the inflow were calculated. The cross-sectional area of the veins were measured. There were a total of 18 children with hydrocephalus, compared to 72 age and sex matched control MRV’s and 22 control flow quantification studies. In hydrocephalus, the sagittal sinus venous return was reduced by 12.9%, but the straight sinus flow was not significantly different. The superficial territory veins were 22% larger than the controls but the vein of Galen was unchanged. There is evidence of a significant increase in the superficial vein transmural pressure in childhood hydrocephalus estimated to be approximately 4 mmHg. An impedance pump model is suggested to explain these findings.
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Affiliation(s)
- Grant A Bateman
- Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Center, Newcastle, NSW, 2310, Australia. .,Newcastle University Faculty of Health, Callaghan Campus, Newcastle, NSW, Australia.
| | - Alexander R Bateman
- School of Mechanical Engineering, University of New South Wales, Sydney, NSW, Australia
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8
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Significant venous flow alterations following brain arteriovenous malformation Surgery: Assessment by transcranial colour duplex. J Clin Neurosci 2022; 99:268-274. [DOI: 10.1016/j.jocn.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022]
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Zahl SM, Mack JA, Rossant C, Squier W, Wester K. Thrombosis is not a marker of bridging vein rupture in infants with alleged abusive head trauma. Acta Paediatr 2021; 110:2686-2694. [PMID: 33964045 PMCID: PMC8519117 DOI: 10.1111/apa.15908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
Aim Thrombosis of bridging veins has been suggested to be a marker of bridging vein rupture, and thus AHT, in infants with subdural haematoma. Methods This is a non‐systematic review based on Pubmed search, secondary reference tracking and authors’ own article collections. Results Radiological studies asserting that imaging signs of cortical vein thrombosis were indicative of traumatic bridging vein rupture were unreliable as they lacked pathological verification of either thrombosis or rupture, and paid little regard to medical conditions other than trauma. Autopsy attempts at confirmation of ruptured bridging veins as the origin of SDH were fraught with difficulty. Moreover, microscopic anatomy demonstrated alternative non‐traumatic sources of a clot in or around bridging veins. Objective pathological observations did not support the hypothesis that a radiological finding of bridging vein thrombosis was the result of traumatic rupture by AHT. No biomechanical models have produced reliable and reproducible data to demonstrate that shaking alone can be a cause of bridging vein rupture. Conclusion There is no conclusive evidence supporting the hypothesis that diagnostic imaging showing thrombosed bridging veins in infants correlates with bridging vein rupture. Hence, there is no literature support for the use of thrombosis as a marker for AHT.
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Affiliation(s)
| | - Julie A. Mack
- Penn State Hershey Medical Center Department of Radiology Hershey PA USA
| | | | - Waney Squier
- Formerly Department of Neuropathology John Radcliffe Hospital Oxford UK
| | - Knut Wester
- Department of Clinical Medicine K1 University of Bergen Bergen Norway
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10
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Baumgarten C, Aggad M, Kerdiles G, Amelot A. Massive cerebral venous air embolism promoting fatal subdural hematoma? Neurochirurgie 2021; 68:252-254. [PMID: 33915147 DOI: 10.1016/j.neuchi.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Affiliation(s)
- C Baumgarten
- Department of Neurosurgery, University Hospital of Grenoble, France.
| | - M Aggad
- Department of Neurosurgery, University Hospital of Tours, France
| | - G Kerdiles
- Department of Neurosurgery, University Hospital of Tours, France
| | - A Amelot
- Department of Neurosurgery, University Hospital of Tours, France
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Pasarikovski CR, Ku JC, Keith J, Ramjist J, Dobashi Y, Priola SM, da Costa L, Yang VXD. Endovascular Cerebral Venous Sinus Imaging with Optical Coherence Tomography. AJNR Am J Neuroradiol 2020; 41:2292-2297. [PMID: 33214185 DOI: 10.3174/ajnr.a6909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/28/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging of the cerebral venous sinuses has evolved Substantially during the past 2 decades, and most recently intravascular sinus imaging with sonography has shed light on the pathophysiology of sinus thrombosis and intracranial hypertension. Optical coherence tomography is the highest resolution intravascular imaging technique available but has not been previously used in cerebral sinus imaging. The purpose of this study was to develop a preclinical animal model of endovascular optical coherence tomography cerebral venous sinus imaging and compare optical coherence tomography findings with histology. MATERIALS AND METHODS Four consecutive Yorkshire swine were selected. The superior sagittal sinus was first catheterized with a microwire, and the optical coherence tomography catheter was delivered via a monorail technique into the sinus. Luminal blood was cleared with a single arterial injection. After structural and Doppler optical coherence tomography imaging, a craniotomy was performed and the sinus and adjacent dura/veins were resected. Bland-Altman analysis was performed to compare optical coherence tomography and histology. RESULTS Technically successful optical coherence tomography images were obtained in 3 of 4 swine. The luminal environment and visualization of dural arteries and draining cortical veins were characterized. The average maximum diameters of the sinus, dural arteries, and cortical veins were 3.14 mm, 135 µm, and 260 µm, respectively. Bland-Altman analysis demonstrated good agreement between histology and optical coherence tomography images. CONCLUSIONS Endovascular optical coherence tomography imaging was feasible in this preclinical animal study. Adoption of this imaging technique in the human cerebral venous sinus could aid in the diagnosis, treatment, and understanding of the pathophysiology of various diseases of the sinus. Human safety and feasibility studies are needed.
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Affiliation(s)
- C R Pasarikovski
- From the Division of Neurosurgery (C.R.P., J.C.K.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - J C Ku
- From the Division of Neurosurgery (C.R.P., J.C.K.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - J Keith
- Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - J Ramjist
- Division of Neurosurgery (J.R., Y.D., L.d.C., V.X.D.Y.), Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Y Dobashi
- Division of Neurosurgery (J.R., Y.D., L.d.C., V.X.D.Y.), Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - S M Priola
- Division of Neurosurgery (S.M.P.), Department of Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - L da Costa
- Division of Neurosurgery (J.R., Y.D., L.d.C., V.X.D.Y.), Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - V X D Yang
- Division of Neurosurgery (J.R., Y.D., L.d.C., V.X.D.Y.), Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program (V.X.D.Y.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Cortical and bridging veins of the upper cerebral convexity: a magnetic resonance imaging study. Surg Radiol Anat 2020; 43:235-242. [PMID: 32964269 DOI: 10.1007/s00276-020-02579-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE There is no study exploring the cortical veins (CVs) and connecting bridging veins (BVs) with neuroimaging modalities. The present study aimed to characterize these veins of the upper cerebral convexity. METHODS A total of 89 patients with intact cerebral hemispheres and covering meninges underwent thin-sliced, contrast magnetic resonance imaging (MRI). In addition, three injected specimens were dissected in this study. RESULTS In cadaver dissection, the BVs were observed to course in the arachnoid sheaths, suspended from the dura mater. The medial parts of the BVs, located near the superior sagittal sinus (SSS)-BV junction site, were occasionally exposed subdurally. The CVs were formed by venous channels arising from the cerebral gyri and those emerging from the sulci. On MRI, the CVs and connecting BVs were identified in the medial and latera convexity areas and medial surface of the cerebrum. These veins were highly variable in number, thickness, length, course, and distribution. In the medial convexity area, the CVs arising from the gyri were identified in 58% of patients, while they were found only in 11% of patients in the lateral convexity area. CONCLUSION In the medial convexity area, involving the parasagittal region, the CVs connect more densely with the BVs that may predispose to injury during neurosurgical procedures. Mechanical impact exerted the area, diameter of the veins in the craniocaudal direction, and number of venous afferences may affect the SSS-BV junctional region in an indirect manner and lead to the development of acute subdural hematoma.
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Ha BJ, Bae IS, Kim JM, Cheong JH, Ryu JI, Han MH. Effects of Possible Osteoporotic Conditions on the Recurrence of Chronic Subdural Hematoma. Front Neurol 2020; 11:538257. [PMID: 33071940 PMCID: PMC7542308 DOI: 10.3389/fneur.2020.538257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/27/2020] [Indexed: 01/30/2023] Open
Abstract
The recurrence rate of chronic subdural hematoma (CSDH) has been reported to range from 2.3 to 33%. As bridging veins are composed of abundant collagen bundles and bone matrix, we aimed to investigate the possible associations between skull Hounsfield unit (HU) values and the recurrence of CSDH. We retrospectively enrolled patients with CSDH who underwent burr hole surgery. The HU values of the frontal skull were measured on brain CT scans. The cumulative hazard for recurrence was estimated according to predictive factors. To identify the independent predictors associated with the recurrence of CSDH, hazard ratios (HRs) were estimated using multivariate Cox regression analysis. A total of 208 consecutive patients who underwent burr hole trephination for CSDH over a 7-years period at a single institution were enrolled in this study. We found that age, greater midline shift (≥10.5 mm), lower skull HU (<769.5), and diabetes were independent predictors for the recurrence of CSDH (HR 1.06, 95% confidence interval [CI] 1.00–1.12, p = 0.042; HR 5.37, 95% CI 1.48–19.46, p = 0.010; HR 6.71, 95% CI 1.84–24.45, p = 0.004; and HR 3.30, 95% CI 1.05–10.43, p = 0.042, respectively). A relationship between possible low bone mineral density (BMD) and CSDH recurrence was observed. In addition, age, greater preoperative midline shift, and diabetes were also identified as predictive factors for recurrence. We expect that our findings may facilitate our understanding of the possible association between CSDH and BMD.
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Affiliation(s)
- Byeong Jin Ha
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - In-Suk Bae
- Department of Neurosurgery, Eulji University Hospital, Seoul, South Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
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15
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Collagen fibre orientation in human bridging veins. Biomech Model Mechanobiol 2020; 19:2455-2489. [PMID: 32535740 DOI: 10.1007/s10237-020-01349-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
Bridging veins (BVs) drain the blood from the cerebral cortex into dural sinuses. BVs have one end attached to the brain and the other to the superior sagittal sinus (SSS), which is attached to the skull. Relative movement between these two structures can cause BV to rupture producing acute subdural haematoma, a head injury with a mortality rate between 30 and 90%. A clear understanding of the BVs microstructure is required to increase the biofidelity of BV models when simulating head impacts. Twelve fresh BV samples draining in the superior sagittal sinus (SSS) from a single human cadaver were cut open along their length and placed on an inverted multiphoton microscope. To ensure that the BVs were aligned with the axial direction an in-house built, uniaxial tension set-up was used. Two scans were performed per sample. Before the first scan, a minor displacement was applied to align the tissue; then, a second scan was taken applying 50% strain. Each BV was scanned for a length of 5 mm starting from the drainage site into the SSS. Imaging was performed on a Zeiss LSM780 microscope with an 25[Formula: see text] water immersion objective (NA 0.8), coupled to a tunable MaiTai DS (Spectraphysics) pulsed laser with the wavelength set at 850 nm. Second harmonic and fluorescence signals were captured in forward and backward direction on binary GaAsP (BiG) detectors and stored as four colour Z-stacks. Prior to the calculation of the local orientations, acquired Z-stacks were denoised and enhanced to highlight fibrillar structures from the background. Then, for each Z-plane of the stack, the ImageJ plugin OrientationJ was used to extract the local 2D orientations of the fibres based on structure tensors. Two kinds of collagen architectures were seen. The most common (8[Formula: see text]12 samples) was single layered and had a uniform distribution of collagen. The less common (4[Formula: see text]12 samples) had 2 layers and 7 to 34 times thicker collagen bundles on the outer layer. Fibre angle analysis showed that collagen was oriented mainly along the axial direction of the vessel. The von Mises fittings showed that in order to describe the fibre distribution 3 components were needed with mean angles [Formula: see text] at [Formula: see text] 0.35, 0.21, [Formula: see text] 0.02 rad or [Formula: see text] 20.2[Formula: see text], 12.1[Formula: see text], [Formula: see text] 1.2[Formula: see text] relative to the vessel's axial direction which was also the horizontal scan direction.
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Shafqat Q, Christensen J, Hamilton AM, Imhof E, Mychasiuk RM, Dunn JF. Acute Dilation of Venous Sinuses in Animal Models of Mild Traumatic Brain Injury Detected Using 9.4T MRI. Front Neurol 2020; 11:307. [PMID: 32411081 PMCID: PMC7198763 DOI: 10.3389/fneur.2020.00307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a debilitating but extremely common form of brain injury that affects a substantial number of people each year. mTBI is especially common in children and adolescents. Our understanding of mTBI pathophysiology is limited, and there is currently no accepted marker for disease severity. A potential marker for disease severity may be cerebrovascular dysfunction. Recent findings have implicated cerebrovascular alteration as an important component of mTBI and suggest it contributes to the development of persistent, long-term symptoms. In this paper, we conducted two studies to investigate whether mTBI affects venous drainage patterns in the central nervous system using alterations in the size of venous sinuses as a marker of changes in drainage. Using a closed head vertical weight-drop model and a lateral impact injury model of mTBI, we imaged and quantified the size of three major draining vessels in the adolescent rat brain using 9.4T MRI. Areas and volumes were quantified in the superior sagittal sinus and left and right transverse sinuses using images acquired from T2w MRI in one study and post-gadolinium T1w MRI in another. Our results indicated that the three venous sinuses were significantly larger in mTBI rats as compared to sham rats 1-day post injury but recovered to normal size 2 weeks after. Acutely enlarged sinuses post-mTBI may indicate abnormal venous drainage, and this could be suggestive of a cerebrovascular response to trauma.
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Affiliation(s)
- Qandeel Shafqat
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennaya Christensen
- Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - A Max Hamilton
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Elizabeth Imhof
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Richelle M Mychasiuk
- Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jeff F Dunn
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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17
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Yedavalli V, Telischak NA, Jain MS, Massoud TF. Three-Dimensional Angles of Confluence of Cortical Bridging Veins and the Superior Sagittal Sinus on MR Venography: Does Drainage of Adjacent Brain Arteriovenous Malformations Alter this Spatial Configuration? Clin Anat 2019; 33:293-299. [PMID: 31749197 DOI: 10.1002/ca.23521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/27/2019] [Indexed: 11/11/2022]
Abstract
Few neuroimaging anatomic studies to date have investigated in detail the point of entry of cortical bridging veins (CBVs) into the superior sagittal sinus (SSS). Although we know that most CBVs join the SSS at an acute angle opposite to the direction of SSS blood flow, the three-dimensional (3-D) spatial configuration of these venous confluences has not been studied previously. This anatomical information would be pertinent to several clinically applicable scenarios, such as in planning intracranial surgical approaches that preserve bridging veins; studying anatomical factors in the pathophysiology of SSS thrombosis; and when planning endovascular microcatheterization of pial veins to retrogradely embolize brain arteriovenous malformations (AVMs). We used the concept of Euclidean planes in 3-D space to calculate the arccosine of these CBV-SSS angles of confluence. To test the hypothesis that pial AVM draining veins may not be any more acutely angled or difficult to microcatheterize at the SSS than for normal CBVs, we measured 70 angles of confluence on magnetic resonance venography images of 11 normal, and nine AVM patients. There was no statistical difference between normal and AVM patients in the CBV-SSS angles projected in 3-D space (56.2° [SD = 22.4°], and 46.2° [SD = 22.3°], respectively; P > 0.05). Hence, participation of CBVs in drainage of pial AVMs should not confer any added difficulty to their microcatheterization across the SSS, when compared to the acute angles found in normal individuals. This has useful implications for potential choices of strategies requiring endovascular transvenous retrograde approaches to treat AVMs. Clin. Anat. 33:293-299, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Vivek Yedavalli
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Nicholas A Telischak
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Mika S Jain
- Department of Physics, Stanford University School of Humanities and Sciences, Stanford, California.,Department of Computer Science, Stanford University School of Engineering, Stanford, California
| | - Tarik F Massoud
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, California
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18
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Várallyay P, Nagy Z, Szűcs A, Czigléczki G, Markia B, Nagy G, Osztie É, Vajda J, Vitanovics D. Miyazaki syndrome: Cervical myelo/radiculopathy caused by overshunting. A systematic review. Clin Neurol Neurosurg 2019; 186:105531. [DOI: 10.1016/j.clineuro.2019.105531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/19/2019] [Accepted: 09/21/2019] [Indexed: 11/16/2022]
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19
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Zhang T, Hernandez O, Chrapkiewicz R, Shai A, Wagner MJ, Zhang Y, Wu CH, Li JZ, Inoue M, Gong Y, Ahanonu B, Zeng H, Bito H, Schnitzer MJ. Kilohertz two-photon brain imaging in awake mice. Nat Methods 2019; 16:1119-1122. [PMID: 31659327 PMCID: PMC9438750 DOI: 10.1038/s41592-019-0597-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 07/25/2019] [Accepted: 09/11/2019] [Indexed: 02/03/2023]
Abstract
Two-photon microscopy is a mainstay technique for imaging in scattering media and normally provides frame-acquisition rates of ~10–30 Hz. To track high-speed phenomena, we created a two-photon microscope with 400 illumination beams that collectively sample 95,000–211,000 μm2 areas at rates up to 1 kHz. Using this microscope, we visualized microcirculatory flow, fast venous constrictions, and neuronal Ca2+ spiking with millisecond-scale timing resolution in the brains of awake mice.
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20
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Jakimovski D, Topolski M, Kimura K, Marr K, Gandhi S, Ramasamy DP, Bergsland N, Hagemeier J, Weinstock-Guttman B, Zivadinov R. Abnormal venous postural control: multiple sclerosis-specific change related to gray matter pathology or age-related neurodegenerative phenomena? Clin Auton Res 2018; 29:329-338. [PMID: 30120624 DOI: 10.1007/s10286-018-0555-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/03/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Autonomic nervous system dysfunction has been previously observed in multiple sclerosis (MS) patients. OBJECTIVE To assess associations between magnetic resonance imaging-detected neuroinflammatory and neurodegenerative pathology and postural venous flow changes indicative of autonomic nervous system function. METHODS We used a standardized 3T magnetic resonance imaging protocol to scan 138 patients with MS and 49 healthy controls. Lesion volume and brain volumes were assessed. The cerebral venous flow (CVF) was examined by color-Doppler sonography in supine and upright positions and the difference was calculated as ΔCVF. Based on ΔCVF, subjects were split into absolute or quartile groups. Student's t test, χ2-test, and analysis of covariance adjusted for age and sex were used accordingly. Benjamini-Hochberg procedure corrected the p-values for multiple comparisons. RESULTS No differences were found between healthy controls and patients with MS in both supine and upright Doppler-derived CVF, nor in prevalence of abnormal postural venous control. Patients with absolute negative ΔCVF had higher disability scores (p = 0.013), lower gray matter (p = 0.039) and cortical (p = 0.044) volumes. The negative ΔCVF MS group also showed numerically worse bladder/bowel function when compared to the positive ΔCVF (2.3 vs. 1.5, p = 0.052). Similarly, the lowest quartile ΔCVF MS group had higher T1-lesion volumes (p = 0.033), T2-lesion volumes (p = 0.032), and lower deep gray matter (p = 0.043) and thalamus (p = 0.033) volumes when compared to those with higher ΔCVF quartiles. CONCLUSION No difference in postural venous outflow between patients with MS and healthy controls was found. However, when the abnormal ΔCVF is present within the MS population, it may be associated with more inflammatory and neurodegenerative pathology. Further studies should explore whether the orthostatic venous changes are an aging or an MS-related phenomenon and if the etiology is due to impaired autonomic nervous system functioning.
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Affiliation(s)
- Dejan Jakimovski
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Matthew Topolski
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Kana Kimura
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Karen Marr
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Sirin Gandhi
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Deepa P Ramasamy
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Jesper Hagemeier
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs MS Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA. .,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
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21
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Sampaolo S, Liguori G, Vittoria A, Napolitano F, Lombardi L, Figols J, Melone MAB, Esposito T, Di Iorio G. First study on the peptidergic innervation of the brain superior sagittal sinus in humans. Neuropeptides 2017; 65:45-55. [PMID: 28460791 DOI: 10.1016/j.npep.2017.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/15/2017] [Accepted: 04/22/2017] [Indexed: 11/24/2022]
Abstract
The superior sagittal sinus (SSS) of the mammalian brain is a pain-sensitive intracranial vessel thought to play a role in the pathogenesis of migraine headaches. Here, we aimed to investigate the presence and the potential co-localization of some neurotransmitters in the human SSS. Immunohistochemical and double-labeling immunofluorescence analyses were applied to paraformaldehyde-fixed, paraffin-embedded, coronal sections of the SSS. Protein extraction and Western blotting technique were performed on the same material to confirm the morphological data. Our results showed nerve fibers clustered mainly in large bundles tracking parallel to the longitudinal axis of the sinus, close in proximity to the vascular endothelium. Smaller fascicles of fibers encircled the vascular lumen in a spiral fashion, extending through the subendothelial connective tissue. Isolated nerve fibers were observed around the openings of bridging veins in the sinus or around small vessels extending into the perisinusal dura. The neurotransmitters calcitonin gene related peptide (CGRP), substance P (SP), neuronal nitric oxide synthase (nNOS), vasoactive intestinal polypeptide (VIP), tyrosine hydroxylase (TH), and neuropeptide Y (NPY) were found in parietal nerve structures, distributed all along the length of the SSS. Overall, CGRP- and TH-containing nerve fibers were the most abundant. Neurotransmitters co-localized in the same fibers in the following pairs: CGRP/SP, CGRP/NOS, CGRP/VIP, and TH/NPY. Western blotting analysis confirmed the presence of such neurosubstances in the SSS wall. Overall our data provide the first evidence of the presence and co-localization of critical neurotransmitters in the SSS of the human brain, thus contributing to a better understanding of the sinus functional role.
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Affiliation(s)
- Simone Sampaolo
- Department of Medicine, Surgery, Neurology, Metabolic and Aging Science and Interuniversity Center for Research in Neurosciences, Second University of Naples, Italy
| | - Giovanna Liguori
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Alfredo Vittoria
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Filomena Napolitano
- Department of Medicine, Surgery, Neurology, Metabolic and Aging Science and Interuniversity Center for Research in Neurosciences, Second University of Naples, Italy; Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", National Research Council, Naples, Italy
| | - Luca Lombardi
- Department of Medicine, Surgery, Neurology, Metabolic and Aging Science and Interuniversity Center for Research in Neurosciences, Second University of Naples, Italy
| | - Javier Figols
- Department of Pathology, Hospital Valdecilla, University of Cantabria Medical School, Santander, Spain
| | - Mariarosa Anna Beatrice Melone
- Department of Medicine, Surgery, Neurology, Metabolic and Aging Science and Interuniversity Center for Research in Neurosciences, Second University of Naples, Italy
| | - Teresa Esposito
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", National Research Council, Naples, Italy; URT-IGB IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Giuseppe Di Iorio
- Department of Medicine, Surgery, Neurology, Metabolic and Aging Science and Interuniversity Center for Research in Neurosciences, Second University of Naples, Italy.
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22
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Squier W, Mack J, Jansen AC. Infants dying suddenly and unexpectedly share demographic features with infants who die with retinal and dural bleeding: a review of neural mechanisms. Dev Med Child Neurol 2016; 58:1223-1234. [PMID: 27435495 DOI: 10.1111/dmcn.13202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 01/01/2023]
Abstract
The cause of death in infants who die suddenly and unexpectedly (sudden unexpected death in infancy [SUDI]) remains a diagnostic challenge. Some infants have identified diseases (explained SUDI); those without explanation are called sudden infant death syndrome (SIDS). Demographic data indicate subgroups among SUDI and SIDS cases, such as unsafe sleeping and apparent life-threatening events. Infants dying suddenly with retinal and dural bleeding are often classified as abused, but in many there is no evidence of trauma. Demographic features suggest that they may represent a further subgroup of SUDI. This review examines the neuropathological hypotheses to explain SIDS and highlights the interaction of infant oxygen-conserving reflexes with the brainstem networks considered responsible for SIDS. We consider sex- and age-specific vulnerabilities related to dural bleeding and how sensitization of the dural innervation by bleeding may influence these reflexes, potentially leading to collapse or even death after otherwise trivial insults.
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Affiliation(s)
- Waney Squier
- Formerly Department of Neuropathology, Oxford University John Radcliffe Hospital, Oxford, UK
| | - Julie Mack
- Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Anna C Jansen
- Paediatric Neurology Unit, Department of Paediatrics, UZ Brussel, Brussels, Belgium.,Neurogenetics Research Unit, Vrije Universiteit Brussel, Brussels, Belgium
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23
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Barami K. Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion. Neurosurg Focus 2016; 41:E9. [DOI: 10.3171/2016.6.focus16172] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Understanding the altered physiology following cerebrospinal fluid (CSF) diversion in the setting of adult hydrocephalus is important for optimizing patient care and avoiding complications. There is mounting evidence that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. An evolved mechanism acting at the cortical bridging veins, known as the “Starling resistor,” prevents overdrainage of cranial venous blood with upright positioning. This protective mechanism can become nonfunctional after CSF diversion, which can result in posture-related cerebral venous overdrainage through the cranial venous outflow tracts, leading to pathological states. This review article summarizes the relevant anatomical and physiological bases of the relationship between the craniospinal venous and CSF compartments and surveys complications that may be explained by the cerebral venous overdrainage phenomenon. It is hoped that this article adds a new dimension to our therapeutic methods, stimulates further research into this field, and ultimately improves our care of these patients.
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24
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Kudo K, Liu T, Murakami T, Goodwin J, Uwano I, Yamashita F, Higuchi S, Wang Y, Ogasawara K, Ogawa A, Sasaki M. Oxygen extraction fraction measurement using quantitative susceptibility mapping: Comparison with positron emission tomography. J Cereb Blood Flow Metab 2016; 36:1424-33. [PMID: 26661168 PMCID: PMC4976745 DOI: 10.1177/0271678x15606713] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 08/03/2015] [Indexed: 11/15/2022]
Abstract
The purposes of this study are to establish oxygen extraction fraction (OEF) measurements using quantitative susceptibility mapping (QSM) of magnetic resonance imaging (MRI), and to compare QSM-OEF data with the gold standard (15)O positron emission tomography (PET). Twenty-six patients with chronic unilateral internal carotid artery or middle cerebral artery stenosis or occlusion, and 15 normal subjects were included. MRI scans were conducted using a 3.0 Tesla scanner with a three-dimensional spoiled gradient recalled sequence. QSM images were created using the morphology-enabled dipole inversion method, and OEF maps were generated from QSM images using extraction of venous susceptibility induced by deoxygenated hemoglobin. Significant correlation of relative OEF ratio to contra-lateral hemisphere between QSM-OEF and PET-OEF was observed (r = 0.62, p < 0.001). The local (intra-section) correlation was also significant (r = 0.52, p < 0.001) in patients with increased PET-OEF. The sensitivity and specificity of OEF increase in QSM was 0.63 (5/8) and 0.89 (16/18), respectively, in comparison with PET. In conclusion, good correlation was achieved between QSM-OEF and PET-OEF in the identification of elevated OEF in affected hemispheres of patients with unilateral chronic steno-occlusive disease.
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Affiliation(s)
- Kohsuke Kudo
- Division of Ultra-High Field MRI, Iwate Medical University, Japan Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Japan
| | - Tian Liu
- Departments of Radiology, Weill Cornell Medical College, New York, NY, USA MedImageMetric LLC, New York, NY, USA
| | | | - Jonathan Goodwin
- Division of Ultra-High Field MRI, Iwate Medical University, Japan
| | - Ikuko Uwano
- Division of Ultra-High Field MRI, Iwate Medical University, Japan
| | - Fumio Yamashita
- Division of Ultra-High Field MRI, Iwate Medical University, Japan
| | - Satomi Higuchi
- Division of Ultra-High Field MRI, Iwate Medical University, Japan
| | - Yi Wang
- Departments of Radiology, Weill Cornell Medical College, New York, NY, USA
| | | | - Akira Ogawa
- Department of Neurosurgery, Iwate Medical University, Japan
| | - Makoto Sasaki
- Division of Ultra-High Field MRI, Iwate Medical University, Japan
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25
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The cerebral venous system and the postural regulation of intracranial pressure: implications in the management of patients with cerebrospinal fluid diversion. Childs Nerv Syst 2016; 32:599-607. [PMID: 26767844 DOI: 10.1007/s00381-015-3010-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
Loss of cerebrospinal fluid (CSF) occurs commonly in daily neurosurgical practice. Understanding the altered physiology following CSF loss is important for optimization of patient care and avoidance of complications. There is overwhelming evidence now that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. The CSF and cerebral venous compartments are tightly coupled in two important ways. CSF is resorbed into the venous system, and there is also an evolved mechanism that prevents overdrainage of venous blood with upright positioning known as the Starling resistor. With loss of CSF pressure, this protective mechanism could become nonfunctional which may result in posture-related venous overdrainage through the cranial venous outflow tracts leading to pathologic states. This review article summarizes the relevant anatomic and physiologic basis of the relationship between the craniospinal venous and CSF compartments in the setting of CSF diversion. It is hoped that this article improves our understanding of ICP dynamics after CSF loss, adds a new dimension to our therapeutic methods, stimulates further research into this field, and ultimately improves our care of these patients.
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26
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Amato MCM, Tirapelli LF, Carlotti CG, Colli BO. Straight sinus: ultrastructural analysis aimed at surgical tumor resection. J Neurosurg 2016; 125:494-507. [PMID: 26745473 DOI: 10.3171/2015.6.jns15584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Accurate knowledge of the anatomy of the straight sinus (SS) is relevant for surgical purposes. During one surgical procedure involving the removal of part of the SS wall, the authors observed that the venous blood flow was maintained in the SS, possibly through a vein-like structure within the dural sinus or dural multiple layers. This observation and its divergence from descriptions of the histological features of the SS walls motivated the present study. The authors aimed to investigate whether it is possible to dissect the SS walls while keeping the lumen intact, and to describe the histological and ultrastructural composition of the SS wall. METHODS A total of 22 cadaveric specimens were used. The SS was divided into three portions: anterior, middle, and posterior. The characteristics of the SS walls were analyzed, and the feasibility of dissecting them while keeping the SS lumen intact was assessed. The thickness and the number of collagen fibers and other tissues in the SS walls were compared with the same variables in other venous sinuses. Masson's trichrome and Verhoeff's stains were used to assess collagen and elastic fibers, respectively. The data were analyzed using Zeiss image analysis software (KS400). RESULTS A vein-like structure independent of the SS walls was found in at least one of the portions of the SS in 8 of 22 samples (36.36%). The inferior wall could be delaminated in at least one portion in 21 of 22 samples (95.45%), whereas the lateral walls could seldom be delaminated. The inferior wall of the SS was thicker (p < 0.05) and exhibited less collagen and greater amounts of other tissues-including elastic fibers, connective tissue, blood vessels, and nerve fibers (p < 0.05)-compared with the lateral walls. Transmission electron microscopy revealed the presence of muscle fibers at a level deeper than that of the subendothelial connective tissue in the inferior wall of the SS, extending from its junction with the great cerebral vein to the confluence of sinuses. CONCLUSIONS The presence of a structure within the SS that can maintain the venous blood flow despite the dural wall might be considered an anatomical variation. The greater thickness of the inferior wall of the SS compared with the lateral walls is mainly due to the presence of larger amounts of tissues other than collagen. Delamination of the inferior wall of the SS was mostly possible in its inferior wall, but an attempt to delaminate the lateral walls is not recommended. Ultrastructural assessment corroborated a recent report of the presence of muscle fibers in the inferior wall of the SS.
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Affiliation(s)
| | - Luis Fernando Tirapelli
- Division of Anatomy, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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27
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Lewis PM, Smielewski P, Rosenfeld JV, Pickard JD, Czosnyka M. A continuous correlation between intracranial pressure and cerebral blood flow velocity reflects cerebral autoregulation impairment during intracranial pressure plateau waves. Neurocrit Care 2015; 21:514-25. [PMID: 24865272 DOI: 10.1007/s12028-014-9994-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the healthy brain, small oscillations in intracranial pressure (ICP) occur synchronously with those in cerebral blood volume (CBV), cerebrovascular resistance, and consequently cerebral blood flow velocity (CBFV). Previous work has shown that the usual synchrony between ICP and CBFV is lost during intracranial hypertension. Moreover, a continuously computed measure of the ICP/CBFV association (Fix index) was a more sensitive predictor of outcome after traumatic brain injury (TBI) than a measure of autoregulation (Mx index). In the current study we computed Fix during ICP plateau waves, to observe its behavior during a defined period of cerebrovascular vasodilatation. METHODS Twenty-nine recordings of arterial blood pressure (ABP), ICP, and CBFV taken during ICP plateau waves were obtained from the Addenbrooke's hospital TBI database. Raw data was filtered prior to computing Mx and Fix according to previously published methods. Analyzed data was segmented into three phases (pre, peak, and post), and a median value of each parameter was stored for analysis. RESULTS ICP increased from a median of 22-44 mmHg before falling to 19 mmHg. Both Mx and Fix responded to the increase in ICP, with Mx trending toward +1, while Fix trended toward -1. Mx and Fix correlated significantly (Spearman's R = -0.89, p < 0.000001), however, Fix spanned a greater range than Mx. A plot of Mx and Fix against CPP showed a plateau (Mx) or trough (Fix) consistent with a zone of "optimal CPP". CONCLUSIONS The Fix index can identify complete loss of cerebral autoregulation as the point at which the normally positive CBF/CBV correlation is reversed. Both CBF and CBV can be monitored noninvasively using near-infrared spectroscopy (NIRS), suggesting that a noninvasive method of monitoring autoregulation using only NIRS may be possible.
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Affiliation(s)
- Philip M Lewis
- Department of Neurosurgery, Alfred Hospital, 1st Floor, Old Baker Building, Commercial Road, Melbourne, VIC, 3003, Australia,
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28
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Müller LO, Toro EF, Haacke EM, Utriainen D. Impact of CCSVI on cerebral haemodynamics: a mathematical study using MRI angiographic and flow data. Phlebology 2015; 31:305-24. [DOI: 10.1177/0268355515586526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The presence of abnormal anatomy and flow in neck veins has been recently linked to neurological diseases. The precise impact of extra-cranial abnormalities such as stenoses remains unexplored. Methods Pressure and velocity fields in the full cardiovascular system are computed by means of a global mathematical model that accounts for the relationship between pulsating cerebral blood flow and intracranial pressure. Results Our model predicts that extra-cranial strictures cause increased pressure in the cerebral venous system. Specifically, there is a predicted pressure increase of about 10% in patients with a 90% stenoses. Pressure increases are related to significant flow redistribution with flow reduction of up to 70% in stenosed vessels and consequent flow increase in collateral pathways. Conclusions Extra-cranial venous strictures can lead to pressure increases in intra-cranial veins of up to 1.3 mmHg, despite the shielding role of the Starling resistor. The long-term clinical implications of the predicted pressure changes are unclear.
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Affiliation(s)
- LO Müller
- Computer Science Department, National Laboratory for Scientific Computing, LNCC/MCTI, Petrópolis, RJ, Brazil
- Laboratory of Applied Mathematics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy
| | - EF Toro
- Laboratory of Applied Mathematics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy
| | - EM Haacke
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
- Magnetic Resonance Innovations, Inc. Detroit, MI, USA
| | - D Utriainen
- Magnetic Resonance Innovations, Inc. Detroit, MI, USA
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Cranial dural arteriovenous shunts. Part 1. Anatomy and embryology of the bridging and emissary veins. Neurosurg Rev 2014; 38:253-63; discussion 263-4. [PMID: 25468011 DOI: 10.1007/s10143-014-0590-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/22/2014] [Indexed: 10/24/2022]
Abstract
We reviewed the anatomy and embryology of the bridging and emissary veins aiming to elucidate aspects related to the cranial dural arteriovenous fistulae. Data from relevant articles on the anatomy and embryology of the bridging and emissary veins were identified using one electronic database, supplemented by data from selected reference texts. Persisting fetal pial-arachnoidal veins correspond to the adult bridging veins. Relevant embryologic descriptions are based on the classic scheme of five divisions of the brain (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon). Variation in their exact position and the number of bridging veins is the rule and certain locations, particularly that of the anterior cranial fossa and lower posterior cranial fossa are often neglected in prior descriptions. The distal segment of a bridging vein is part of the dural system and can be primarily involved in cranial dural arteriovenous lesions by constituting the actual site of the shunt. The veins in the lamina cribriformis exhibit a bridging-emissary vein pattern similar to the spinal configuration. The emissary veins connect the dural venous system with the extracranial venous system and are often involved in dural arteriovenous lesions. Cranial dural shunts may develop in three distinct areas of the cranial venous system: the dural sinuses and their interfaces with bridging veins and emissary veins. The exact site of the lesion may dictate the arterial feeders and original venous drainage pattern.
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30
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Enhanced global mathematical model for studying cerebral venous blood flow. J Biomech 2014; 47:3361-72. [DOI: 10.1016/j.jbiomech.2014.08.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/29/2014] [Accepted: 08/01/2014] [Indexed: 11/20/2022]
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Famaey N, Ying Cui Z, Umuhire Musigazi G, Ivens J, Depreitere B, Verbeken E, Vander Sloten J. Structural and mechanical characterisation of bridging veins: A review. J Mech Behav Biomed Mater 2014; 41:222-40. [PMID: 25052244 DOI: 10.1016/j.jmbbm.2014.06.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/04/2014] [Accepted: 06/18/2014] [Indexed: 11/17/2022]
Abstract
Bridging veins drain the venous blood from the cerebral cortex into the superior sagittal sinus (SSS) and doing so they bridge the subdural space. Despite their importance in head impact biomechanics, little is known about their properties with respect to histology, morphology and mechanical behaviour. Knowledge of these characteristics is essential for creating a biofidelic finite element model to study the biomechanics of head impact, ultimately leading to the improved design of protective devices by setting up tolerance criteria. This paper presents a comprehensive review of the state-of-the-art knowledge on bridging veins. Tolerance criteria to prevent head injury through impact have been set by a number of research groups, either directly through impact experiments or by means of finite element (FE) simulations. Current state-of-the-art FE head models still lack a biofidelic representation of the bridging veins. To achieve this, a thorough insight into their nature and behaviour is required. Therefore, an overview of the general morphology and histology is provided here, showing the clearly heterogeneous nature of the bridging vein complex, with its three different layers and distinct morphological and histological changes at the region of outflow into the superior sagittal sinus. Apart from a complex morphology, bridging veins also exhibit complex mechanical behaviour, being nonlinear, viscoelastic and prone to damage. Existing material models capable of capturing these properties, as well as methods for experimental characterisation, are discussed. Future work required in bridging vein research is firstly to achieve consensus on aspects regarding morphology and histology, especially in the outflow cuff segment. Secondly, the advised material models need to be populated with realistic parameters through biaxial mechanical experiments adapted to the dimensions of the bridging vein samples. Finally, updating the existing finite element head models with these parameters will render them truly biofidelic, allowing the establishment of accurate tolerance criteria and, ultimately, better head protection devices.
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Affiliation(s)
| | | | | | - Jan Ivens
- Composite Materials Group, Department of Metallurgy and Materials Engineering, KU Leuven, Belgium
| | - Bart Depreitere
- Department of Neurosurgery, University Hospital Gasthuisberg, KU Leuven, Belgium
| | - Erik Verbeken
- Translational Cell & Tissue Research, KU Leuven, Belgium
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32
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Miller JD, Nader R. Acute subdural hematoma from bridging vein rupture: a potential mechanism for growth. J Neurosurg 2014; 120:1378-84. [DOI: 10.3171/2013.10.jns13272] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Most acute subdural hematomas (ASDHs) develop after rupture of a bridging vein or veins. The anatomy of the bridging vein predisposes to its tearing within the border cell layer of the dura mater. Thus, the subdural hematoma actually forms within the dura. The hematoma grows by continued bleeding into the border cell layer. However, the venous pressure would not be expected to cause a large hematoma. Therefore, some type of mechanism must account for the hematoma's expansion.
Cerebral venous pressure (CVP) has been demonstrated in animal models to be slightly higher than intracranial pressure (ICP), and CVP tracks the ICP as pressure variations occur. The elevation of CVP as the ICP increases is thought to result from an increase in outflow resistance of the terminal portion of the bridging veins. This probably results from a Starling resistor model or, less likely, from a muscular sphincter.
A hypothesis is derived to explain the mechanism of ASDH enlargement. Tearing of one or more bridging veins causes these vessels to bleed into the dural border cell layer. Subsequent ICP elevation from the ASDH, cerebral swelling, or other cause results in elevation of the CVP by increased outflow resistance in the intact bridging veins. The increased ICP causes further bleeding into the hematoma cavity via the torn bridging veins. Thus, the ASDH enlarges via a positive feedback mechanism.
Enlargement of an ASDH would cease as blood within the hematoma cavity coagulates. This would stop the dissection of the dural border cell layer, and pressure within the hematoma cavity would equalize with that in the torn bridging vein or veins.
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Affiliation(s)
- Jimmy D. Miller
- 1Division of Neurosurgery, Greenwood Leflore Hospital, Greenwood, Mississippi
| | - Remi Nader
- 2Division of Neurosurgery, University of Texas Medical Branch, Galveston; and
- 3Texas Center for Neurosciences, Beaumont, Texas
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Ivanov AY, Petrov AE, Vershinina EA, Galagudza MM, Vlasov TD. Evidence of active regulation of cerebral venous tone in individuals undergoing embolization of brain arteriovenous malformations. J Appl Physiol (1985) 2013; 115:1666-71. [PMID: 24114702 DOI: 10.1152/japplphysiol.00951.2013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral venous drainage is generally believed to be regulated primarily by hydrodynamic forces. To gain further insight into the regulation of this process, we investigated the response of blood flow velocity and cross-sectional area (CSA) of the internal jugular veins (IJVs) to local hemodynamic shifts. All procedures and assessments were performed on patients (n = 30) undergoing embolization of brain arteriovenous malformations (AVMs). The procedure efficiency was verified by the postembolization reduction in time-averaged maximum blood flow velocities, as well as the elevation of pulsatility index and resistance index in the arterial feeders. In cerebral veins, the dominant IJV pressure remained unchanged during the procedure. At the same time, AVM embolization caused a significant reduction in maximal CSA (84 ± 7.6 to 68 ± 7.7 mm(2), P < 0.05) and minimal CSA (68 ± 7.0 to 51 ± 7.0 mm(2), P < 0.01) of the IJV located ipsilateral to the AVM, while the maximal linear blood flow velocity in the IJV remained unchanged (71 ± 4.9 and 85 ± 8.4 cm/s, P = 0.098). Consistent with previously published studies, the data obtained provide further evidence of active regulation of the venous outflow, probably mediated by certain neurogenic and/or endothelium-dependent mechanisms.
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Affiliation(s)
- Alexey Y Ivanov
- Division of Vascular Surgery, A. L. Polenov Research Institute of Neurosurgery, St. Petersburg, Russian Federation
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Beggs CB. Venous hemodynamics in neurological disorders: an analytical review with hydrodynamic analysis. BMC Med 2013; 11:142. [PMID: 23724917 PMCID: PMC3668302 DOI: 10.1186/1741-7015-11-142] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 02/20/2013] [Indexed: 01/20/2023] Open
Abstract
Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular.CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation.Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius.CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear.
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Affiliation(s)
- Clive B Beggs
- Medical Biophysics Laboratory, School of Engineering, Design and Technology, University of Bradford, Bradford, West Yorkshire BD7 1DP, UK.
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35
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Squier W, Mack J, Green A, Aziz T. The pathophysiology of brain swelling associated with subdural hemorrhage: the role of the trigeminovascular system. Childs Nerv Syst 2012; 28:2005-15. [PMID: 22885686 DOI: 10.1007/s00381-012-1870-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/18/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This paper reviews the evidence in support of the hypothesis that the trigeminal system mediates brain swelling associated with subdural bleeding. The trigeminovascular system has been extensively studied in migraine; it may play an important but under-recognized role in the response to head trauma. Nerve fibers originating in trigeminal ganglion cells are the primary sensors of head trauma and, through their collateral innervation of the intracranial and dural blood vessels, are capable of inciting a cascade of vascular responses and brain swelling. The extensive trigeminal representation in the brainstem initiates and augments autonomic responses. Blood and tissue injury in the dura incite neurogenic inflammatory responses capable of sensitizing dural nerves and potentiating the response to trauma. DISCUSSION The trigeminal system may provide the anatomo-physiological link between small-volume, thin subdural bleeds and swelling of the underlying brain. This physiology may help to explain the poorly understood phenomena of "second-impact syndrome," the infant response to subdural bleeding (the "big black brain"), as well as post-traumatic subdural effusions. Considerable age-specific differences in the density of dural innervation exist; age-specific responses of this innervation may explain differences in the brain's response to trauma in the young. An understanding of this pathophysiology is crucial to the development of intervention and treatment of these conditions. Antagonists to specific neuropeptides of the trigeminal system modify brain swelling after trauma and should be further explored as potential therapy in brain trauma and subdural bleeding.
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Affiliation(s)
- Waney Squier
- Neuropathology, John Radcliffe Hospital, Oxford, UK.
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Nierenberger M, Wolfram-Gabel R, Decock-Catrin S, Boehm N, Rémond Y, Kahn JL, Ahzi S. Investigation of the human bridging veins structure using optical microscopy. Surg Radiol Anat 2012; 35:331-7. [PMID: 23129263 DOI: 10.1007/s00276-012-1035-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 10/19/2012] [Indexed: 11/25/2022]
Abstract
In this paper, we investigated the brain-sinus junction and especially the bridging veins linking these two organs. Two types of optical microscopy were used: conventional optical microscopy and digital microscopy. We used thin histological sections prepared from a human brain, and stained with Masson's trichrome, hemalun and orcein. Finally we observed the path of the bridging vein inside the brain-skull interface. At smaller scales, wavy collagen fiber bundles were found and characterized inside the vein walls. Taking into account the orientations of the different sections with reference to frontal planes, we found that the bridging vein has a very complex geometry, which increases the difficulty to determine fiber orientations in its walls. Nevertheless, we found that collagen fiber bundles are mainly circumferentially oriented in the superior sagittal sinus walls. In this paper, we were able to characterize precisely the path of the bridging vein from the brain to the sinus, with different magnifications.
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Affiliation(s)
- Mathieu Nierenberger
- CNRS, IMFS, University of Strasbourg, 2 Rue Boussingault, 67000 Strasbourg, France.
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37
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Davidson JR, Mack J, Gutnikova A, Varatharaj A, Darby S, Squier W. Developmental changes in human dural innervation. Childs Nerv Syst 2012; 28:665-71. [PMID: 22395537 DOI: 10.1007/s00381-012-1727-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/13/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is limited published work on the abundant innervation of the human dura mater, its role and responses to injury in humans. The dura not only provides mechanical support for the brain but may also have other functions, including control of the outflow of venous blood from the brain via the dural sinuses. The trigeminal nerve supplies sensory fibres to the dura as well as the leptomeninges, intracranial blood vessels, face, nose and mouth. Its relatively large size in embryonic life suggests an importance in development; the earliest fetal reflexes, mediated by the trigeminal, are seen by 8 weeks. Trigeminal functions vital to the fetus include the coordination of sucking and swallowing and the protective oxygen-conserving reflexes. Like other parts of the nervous system, the trigeminal undergoes pruning and remodelling throughout development. METHODS We have investigated changes in the innervation of the human dura with age in 27 individuals aged between 31 weeks of gestation and 60 years of postnatal life. Using immunocytochemistry with antibodies to neurofilament, we have found significant changes in the density of dural innervation with age RESULTS The density of innervation increased between 31 and 40 weeks of gestation, peaking at term and decreasing in the subsequent 3 months, remaining low until the sixth decade. CONCLUSIONS Our observations are consistent with animal studies but are, to our knowledge, the first to show age-related changes in the density of innervation in the human dura. They provide new insights into the functions of the human dura during development.
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Affiliation(s)
- J R Davidson
- Department of Neuropathology, John Radcliffe Hospital, Oxford, UK
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38
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Squier W. The "Shaken Baby" syndrome: pathology and mechanisms. Acta Neuropathol 2011; 122:519-42. [PMID: 21947257 DOI: 10.1007/s00401-011-0875-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/09/2011] [Accepted: 09/11/2011] [Indexed: 01/01/2023]
Abstract
The "Shaken Baby" syndrome (SBS) is the subject of intense controversy; the diagnosis has in the past depended on the triad of subdural haemorrhage (SDH), retinal haemorrhage and encephalopathy. While there is no doubt that infants do suffer abusive injury at the hands of their carers and that impact can cause catastrophic intracranial damage, research has repeatedly undermined the hypothesis that shaking per se can cause this triad. The term non-accidental head injury has therefore been widely adopted. This review will focus on the pathology and mechanisms of the three physiologically associated findings which constitute the "triad" and are seen in infants suffering from a wide range of non-traumatic as well as traumatic conditions. "Sub" dural bleeding in fact originates within the deep layers of the dura. The potential sources of SDH include: the bridging veins, small vessels within the dura itself, a granulating haemorrhagic membrane and ruptured intracranial aneurysm. Most neuropathologists do not routinely examine eyes, but the significance of this second arm of the triad in the diagnosis of Shaken Baby syndrome is such that it merits consideration in the context of this review. While retinal haemorrhage can be seen clinically, dural and subarachnoid optic nerve sheath haemorrhage is usually seen exclusively by the pathologist and only rarely described by the neuroradiologist. The term encephalopathy is used loosely in the context of SBS. It may encompass anything from vomiting, irritability, feeding difficulties or floppiness to seizures, apnoea and fulminant brain swelling. The spectrum of brain pathology associated with retinal and subdural bleeding from a variety of causes is described. The most important cerebral pathology is swelling and hypoxic-ischaemic injury. Mechanical shearing injury is rare and contusions, the hallmark of adult traumatic brain damage, are vanishingly rare in infants under 1 year of age. Clefts and haemorrhages in the immediate subcortical white matter have been assumed to be due to trauma but factors specific to this age group offer other explanations. Finally, examples of the most common causes of the triad encountered in clinical diagnostic and forensic practice are briefly annotated.
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Affiliation(s)
- Waney Squier
- Department of Neuropathology, West Wing, John Radcliffe Hospital, Oxford, UK.
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Tzeng YC, Willie CK, Atkinson G, Lucas SJE, Wong A, Ainslie PN. Cerebrovascular regulation during transient hypotension and hypertension in humans. Hypertension 2010; 56:268-73. [PMID: 20547971 DOI: 10.1161/hypertensionaha.110.152066] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The cerebrovasculature dilates or constricts in response to acute blood pressure changes to stabilize cerebral blood flow across a range of blood pressures. It is unclear, however, whether such dynamic cerebral autoregulation (dCA) is equally effective in responding to falling versus rising blood pressure. In this study we applied a pharmacological approach to evaluate dCA gain to transient hypotension and hypertension and compared this method with 2 established indices of dCA that do not explicitly differentiate between dCA efficacy and falling versus rising blood pressure. Middle cerebral arterial velocity and blood pressure recordings were made in 26 healthy volunteers randomized to 2 protocols. In 10 subjects, dCA gain to transient hypotension induced with intravenous nitroprusside was compared with dCA gain to transient hypertension induced with intravenous phenylephrine. In 16 subjects, dCA gain to transient hypotension induced with intravenous nitroprusside was compared with the rate of regulation and autoregulatory index derived from transient hypotension induced with the thigh cuff deflation technique. dCA gain to transient hypotension induced with intravenous nitroprusside was unrelated to dCA gain to transient hypertension induced with intravenous phenylephrine (r=0.06; P=0.87) and was consistently greater than dCA gain to transient hypertension induced with intravenous phenylephrine (0.57+/-0.16 versus 0.31+/-0.20 cm/s per millimeter of mercury; P<0.01). However, dCA gain to transient hypotension induced with intravenous nitroprusside was inversely related to the rate of regulation (r=-0.52; P=0.037) and autoregulatory index (r=-0.66; P=0.005). These data indicate that, under our laboratory conditions, dCA appears to be inherently nonlinear with disparate efficacy against rising and falling blood pressure, and dCA gain derived from pharmacologically induced transient hypotension correlates with established nonpharmacological indices of dCA.
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Affiliation(s)
- Yu-Chieh Tzeng
- Cardiovascular Systems Laboratory, Physiological Rhythms Unit, Department of Surgery and Anesthesia, University of Otago, Wellington, Wellington South, New Zealand.
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Stolz E, Rüsges DAW, Hoffmann O, Gerriets T, Nedelmann M, Lochner P, Kaps M. Active regulation of cerebral venous tone: simultaneous arterial and venous transcranial Doppler sonography during a Valsalva manoeuvre. Eur J Appl Physiol 2010; 109:691-7. [PMID: 20213466 DOI: 10.1007/s00421-010-1411-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2010] [Indexed: 10/19/2022]
Abstract
The aim of this study was to analyse the cerebral venous outflow in relation to the arterial inflow during a Valsalva manoeuvre (VM). In 19 healthy volunteers (mean age 24.1 +/- 2.6 years), the middle cerebral artery (MCA) and the straight sinus (SRS) were insonated by transcranial Doppler sonography. Simultaneously the arterial blood pressure was recorded using a photoplethysmographic method. Two VM of 10 s length were performed per participant. Tracings of the variables were then transformed to equidistantly re-sampled data. Phases of the VM were analysed regarding the increase of the flow velocities and the latency to the peak. The typical four phases of the VM were also found in the SRS signal. The relative flow velocity (FV) increase was significantly higher in the SRS than in the MCA for all phases, particularly that of phase IV (p < 0.01). Comparison of the time latency of the VM phases of the MCA and SRS only showed a significant difference for phase I (p < 0.01). In particular, there was no significant difference for phase IV (15.8 +/- 0.29 vs. 16.0 +/- 0.28 s). Alterations in venous outflow in phase I are best explained by a cross-sectional change of the lumen of the SRS, while phases II and III are compatible with a Starling resistor. However, the significantly lager venous than the arterial overshoot in phase IV may be explained by the active regulation of the venous tone.
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Affiliation(s)
- Erwin Stolz
- Department of Neurology, Justus-Liebig University, Am Steg 14, 35385 Giessen, Germany.
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Squier W, Mack J. The neuropathology of infant subdural haemorrhage. Forensic Sci Int 2009; 187:6-13. [PMID: 19303229 DOI: 10.1016/j.forsciint.2009.02.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 02/03/2009] [Accepted: 02/09/2009] [Indexed: 10/21/2022]
Abstract
Subdural haemorrhage (SDH) in the infant has a different pattern from that seen in the older child and adult. It is usually a widespread, bilateral, thin film, unlike the thick, space-occupying and often unilateral clot seen in older children and adults after trauma. Whether both arise by the same mechanism is unknown, but it seems unlikely. Most SDH is said to be due to trauma but in infants there are other, atraumatic causes. Birth is also important; recent MRI studies show an incidence of almost 50% in asymptomatic neonates. Traumatic SDH is said to result from rupture of bridging veins but new insights into the anatomy of infant dura suggest a dural origin for thin film subdural bleeding in young babies. Acute SDH usually rapidly resolves, but sometimes develops into a chronic fluid collection. Healing of SDH is by formation of a granulating membrane which may confer vulnerability to rebleeding, either spontaneously or after an otherwise innocuous event. SDH has a particular significance as one of the features of the triad (together with retinal haemorrhage and encephalopathy) associated with non-accidental injury. As the possibility of non-accidental injury is often first raised by a radiologic report of subdural bleeding, it becomes critically important in the interpretation of the scan appearances to understand the unique physiology and anatomy of the infant dura.
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Affiliation(s)
- Waney Squier
- Department of Neuropathology, Level 1, West Wing, John Radcliffe Hospital, Oxford OX39DU, United Kingdom.
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Anatomy and development of the meninges: implications for subdural collections and CSF circulation. Pediatr Radiol 2009; 39:200-10. [PMID: 19165479 DOI: 10.1007/s00247-008-1084-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 11/04/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
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.
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Dagain A, Vignes J, Dulou R, Dutertre G, Delmas J, Guerin J, Liguoro D. Junction between the great cerebral vein and the straight sinus: An anatomical, immunohistochemical, and ultrastructural study on 25 human brain cadaveric dissections. Clin Anat 2008; 21:389-97. [DOI: 10.1002/ca.20635] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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