Abstract
Purpose
For intramedullary tumor (IMT) surgery, a balance has to be found between aggressively resecting the tumor and respecting all the sensory and motor pathways. The most common surgical approach is through the dorsal median sulcus (DMS) of the spinal cord. However, the precise organization of the meningeal sheats in the DMS remains obscure in the otherwise well-described anatomy of the spinal cord. A better understanding of this architecture may be of benefit to IMT surgeon to spare the spinal cord.
Methods
Three spinal cords were studied. The organization of the spinal cord meninges in the DMS was described via macroscopic, microsurgical and optical microscopic views. A micro dissection of the DMS was also performed.
Results
No macroscopic morphological abnormalities were observed. With the operative magnifying lens, the dura was opened, the arachnoid was removed and the pia mater was cut to access the DMS. The histological study showed that the DMS was composed of a thin rim of capillary-carrying connective tissue extending from the pia mater and covering the entire DMS. There was no true space between the dorsal columns, no arachnoid or crossing axons either.
Conclusion
Our work indicates that the DMS is not a sulcus but a thin blade of collagen extending from the pia mater. Its location is given by tiny vessels coming from the surface towards the deep. Thus, the surgical corridor has to follow the DMS as closely as possible to prevent damage to the spinal cord during midline IMT removal.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Brotchi J (2002) Intrinsic spinal cord tumor resection. Neurosurgery 50:1059–1063
Cajal SR (1894) Les nouvelles idées sur la structure du système nerveux chez l’homme et chez les vertébrés. Paris
Cushing H (1905) The special field of neurosurgery. Bulletin of the Johns Hopkins Hospital, Baltimore, pp 77–87
Elsberg CA (1912) Surgery of intramedullary affections of the spinal cord: anatomical basis and technique. JAMA 59:1532–1536
Fischer G, Brotchi J (1994) Les tumeurs intramédullaires. Société de Neuro-Chirurgie de Langue Française, 45ème Congrès Annuel. Angers, 12-15 juin 1994. Neurochirurgie 40(Suppl 1):1–108
Fischer G, Mansuy L (1980) Total removal of intramedullary ependymomas: follow-up study of 16 cases. Surg Neurol 14:243–249
Gowers R, Horsley V (1888) A case of tumour of the spinal cord. Removal; recovery. Med Chir Trans 53:377–428
Hirschfeld L (1865) Traité et iconographie du système nerveux et des organes des sens de l’homme. Paris Masson
Key EAH, Retzius MG (1876) Studien der Anatomie des Nervensystems und des Bindegewebes. Stockholm Samson Wallin, Stockholm
Krause F (1908) Erfahrungen bei 26 operativen Fallen von Ruckenmarkstumoren mit Projektionen. Dtsch Z Nervenheilkd 36:106–113
Lazorthes (1973) Vascularisation et circulation de la moelle épinière. Paris Masson
Lazorthes G, Gouaze A, Zadeh JO, Santini JJ, Lazorthes Y, Burdin P (1971) Arterial vascularization of the spinal cord. Recent studies of the anastomotic substitution pathways. J Neurosurg 35:253–262
Lescanne E, Velut S, Lefrancq T, Destrieux C (2002) The internal acoustic meatus and its meningeal layers: a microanatomical study. J Neurosurg 97:1191–1197
Mertens P, Guenot M, Hermier M, Jouvet A, Tournut P, Froment JL, Sindou M, Carret JP (2000) Radiologic anatomy of the spinal dorsal horn at the cervical level (anatomic-MRI correlations). Surg Radiol Anat 22:81–88
Nauta HJ, Dolan E, Yasargil MG (1983) Microsurgical anatomy of spinal subarachnoid space. Surg Neurol 19:431–437
Nicholas DS, Weller RO (1988) The fine anatomy of the human spinal meninges. A light and scanning electron microscopy study. J Neurosurg 69:276–282
Nieuwenhuys R (1978) The human central nervous system. A Synopsis and Atlas. Springer, Heidelberg
Roux FX, Nataf F, Pinaudeau M, Borne G, Devaux B, Meder JF (1996) Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol 46:458–463
Samii M, Keklamp J (2007) Surgery of spinal tumors. Springer, Baltimore, p 526
Sandalcioglu IE, Hunold A, Muller O, Bassiouni H, Stolke D, Asgari S (2008) Spinal meningiomas: critical review of 131 surgically treated patients. Eur Spine J 17:1035–1041
Testut L (1911) Traité d’Anatomie Humaine. Système nerveux central. Octove Doin, Paris
Vandenabeele F, Creemers J, Lambrichts I (1996) Ultrastructure of the human spinal arachnoid mater and dura mater. J Anat 189(Pt 2):417–430
Weller RO (2005) Microscopic morphology and histology of the human meninges. Morphologie 89:22–34
Déjérine J (1980) Anatomie des centres nerveux. Paris Masson
Acknowledgments
We thank Prof Sindou who was at the origin of this work. We thank the technical staff of the pathology laboratory for their preparation of samples prior to histological analyses. We thank K. Erwin for proofreading the English article.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Rights and permissions
About this article
Cite this article
Jacquesson, T., Streichenberger, N., Sindou, M. et al. What is the dorsal median sulcus of the spinal cord? Interest for surgical approach of intramedullary tumors. Surg Radiol Anat 36, 345–351 (2014). https://doi.org/10.1007/s00276-013-1194-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-013-1194-1