Our knowledge on intracranial pain-sensitive structures in humans comes essentially from observations during neurosurgical procedures performed in awake patients. It is currently accepted that intracranial pain-sensitive structures are limited to the dura mater and its feeding vessels and that small cerebral vessels and pia mater are insensitive to pain, which is inconsistent with some neurosurgical observations during awake craniotomy procedures. We prospectively collected observations of painful events evoked by mechanical stimulation touching, stretching, pressure, or aspiration of intracranial structures during awake craniotomies, routinely performed for intraoperative functional mapping to tailor brain tumour resection in the eloquent area. Intraoperatively, data concerning the locations of pain-sensitive structures were drawn by the surgeon on a template and their corresponding referred pain was indicated by the patient by drawing a cross on a diagram representing the head. Ninety-three painful events were observed and collected in 53 different patients mean age On average, 1.

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We'd like to understand how you use our websites in order to improve them. Register your interest. The nerves supplying the spinal dura mater were studied in four human foetuses 16—22 weeks with the acetylcholinesterase in toto staining method. The ventral spinal dura contains a dense, longitudinally oriented, nerve plexus, which receives its contributions from: I the sinuvertebral nerves, II the nerve plexus of the posterior longitudinal ligament, III the nerve plexus of radicular branches of segmental arteries.


Innervation of the Cerebral Dura Mater

The trigeminovascular system within the cranial dura mater is a possible cause of headaches. The aim of this study is to investigate macroscopically dural innervation around the middle meningeal artery MMA in the middle cranial fossa. Overall, the nervus spinosus NS from either the maxillary or mandibular trigeminal divisions ran along the lateral wall of the middle meningeal vein rather than that of the MMA. Distinct bundles of the NS running along the course of the frontal branches of the MMA were present in Others did not form dominant nerve bundles, instead giving off free nerve endings along the course of the MMA or dural connective tissue.



Dura mater is a thick membrane made of dense irregular connective tissue that surrounds the brain and spinal cord. It is the outermost of the three layers of membrane called the meninges that protect the central nervous system. The other two meningeal layers are the arachnoid mater and the pia mater. The dura surrounds the brain and the spinal cord. It envelops the arachnoid mater , which is responsible for keeping in the cerebrospinal fluid. It is derived primarily from the neural crest cell population, with postnatal contributions of the paraxial mesoderm. The dura mater has several functions and layers.


Dura mater

The trigemino-cardiac reflex during Onyx embolization for dural arteriovenous fistula may be caused by mechanical or chemical stimulus to the terminals of the unencapsulated Ruffini-like receptors stemming from A-axons in the dural connective tissue at sites of dural arteries and sinuses. These afferent pathway nerves are cholinergic innervations of the dura mater, which also contains vasoactive neuropeptides such as calcitonin gene-related peptide, substance P, and neurokinin A. Its efferent pathway has been defined as the acetylcholinergic vagus nerve. The A11 nucleus, located in the posterior hypothalamus, providing the only known source of descending dopaminergic innervation for the spinal grey matter, can inhibit the neurons in the spinal dorsal horn. During endovascular Onyx embolization for intracranial dural arteriovenous fistula, a trigemino-cardiac reflex has been observed 1 , 2. This reflex has been described as the sudden development of cardiac arrhythmia as far as cardiac arrest, arterial hypotension, apnea and gastric hypermobility during stimulation of any of the sensory branches of the trigeminal nerve 1 , 2.

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