| Objective:The myodural bridge(MDB)is a dense connective tissue bridge which connected the suboccipital muscles with the upper spinal cervical dura mater in suboccipital region.Since the concept of the MDB proposed,it has been proved to be commonly existed in Mammalia,Birds and Reptiles.Studies indicated the MDB was a highly evolutionarily conservative structure and the MDB might have important physiological functions.At present,many hypotheses about the physiological functions of the MDB have been put forward,but it still remains unclear.Recently Sui et al.proposed that the suboccipital muscles could pull the spinal dural capsule via the MDB acting as a pump to drive CSF circulation.The suboccipital muscles are the deep group in nuchal muscles,which take part in the movements of head.In this study cerebral spinal fluid(CSF)pressures were monitored during heads moving in order to providing research data in vivo for functional studies of the MDB and a proof of the hypothesis of CSF circulationpower.Marerials and Meathods1.Subjects100 patients(79 men,21 women;aged 17-87 years;mean age,55.40±16.95years)without nervous system diseases or other diseases which could influence the CSF circulation and pressure,and no adverse reaction was found after the operation.2.MaterialsSingle-use puncture anesthesia kit(5#epidural puncture needle,16#nib-type lumbar anaesthesia needle.)and cerebral pressure measuring tube were used in this study3.Experimental procedure3.1 Patients were prepared as regular surgical requirement:The patients were infused with Sodium Potassium Magnesium and Calcium Injection 200ml,and the blood pressure,heart rate and blood oxygen saturation were monitored3.2 Patients maintained lying on the side with the hand,hip and knee joints flexed The surface of back maintained vertical perpendicular,and head cushion is prepared to make sure the head,neck,spine is horizontal3.3 The L3-L4 posterior intervertebral space was selected as the puncture point.A 5#epidural needle and a pen tip type 16#spinal needle were used.When CSF flows out,the piezometer tube was connected3.4 Whenthe fluid level in the piezometer tube slowly rose to be stabilized(stabilization means that the fluid level fluctuates slightly near a certain scale within the tube),the CSF pressure(mmH2O),blood pressure(mmHg),and heart rate(min/min)were recorded.3.5 During 5 times head nodding(approximately 5-7 seconds),the fluid level in the piezometer tube slowly rose and when it became stabilized a few seconds after the head-nodding movement,the CSF pressure(mmH2O),blood pressure(mmHg),and heart rate(times/min)were recordedResults1 The CSF pressures before and after head-nodding were(116.03 ± 26.13)mmH2O and(124.64 ± 26.12)mmH2O,with significantly increasing(P=0.000)in 7%range on average.After head-nodding movement,the heart rates obviously increased and the systolic blood pressure decreased significantly.No significant difference was found in diastolic blood pressure before and after head-nodding movement2 the significant correlations between the blood circulation parameters(heart rates and blood pressures)and the CSF pressures were not found during the head-nodding period p value=0.804,correlation coefficient=0.029 between CSF pressures and heart rates,p value=0.162,correlation coefficient=0.160 between CSF pressures and systolic blood pressures,and p value=0.456,correlation coefficient=-0.087 between CSF pressures and diastolic blood pressures.Conclusion1.Head-nodding movement is a important influencing factor of cerebrospinal fluid pressure.2.Head movement may be the dynamic source of the cerebrospinal fluid circulation.Objective:The myodural bridge(MDB)consists of fibers from the rectus capitis posterior major(RCPma),rectus capitis posterior minor(RCPmi)and obliquus capitis inferior(OCI),and connects the suboccipital muscles to the spinal dura mater through the posterior atlantooccipital and atlantoaxial interspaces.At present,it is not clear about the physiological function of the MDB.We believe that it maybe play a role in driving the cerebral spinal fluid circulation.It was found in our experiments in vivo that head movements had significant effects on the cerebral spinal fluid circulation.In order to explore whether the suboccipital muscles and their MDBs take part in the above function The spatial position of the suboccipital muscle would be focus on.Rencently the digital spatial position of the suboccipital muscle has not been reported.Based on the image data of head and neck,the digital spatial position and three-dimensional reconstruction of the RCPma,RCPmi and OCI were shown via the Minics softwir in this study to reveal the spatial distributions of the above three muscles and its relative positional relationship with the dura mater.Materials and Methods:1.Subjects:1 case of digital human head and neck data provided by the Third Military Medical University.2.Procedure:2.1 Image segmentation:the different structures in the original image were separeted into different layers which filled with distinct colors,and the corresponding layers were named as the structure,and the position of each layer were adjusted to show the structures of the original image with different colors2.2 Three-dimensional reconstruction:On the basis of image segmentation,the colorful parts of the original image will be the screenshots for the Three-dimensional reconstruction,and a set of screenshot files of colorful structures in different layers are obtained for Three-dimensional reconstruction.The minics is opened.And the voxel was set to 0.12*0.12*1mm,select the range of gray values of different structure colors to reconstruct,and redefine the color of each structure.This color setting is used to distinguish the structure during the later observation and analysis,and the differences of gray value can be ignored2.3 Analysis data:In order to understand the spatial distribution information of the three muscles,minics was used to measure the position angle of RCPmi,RCPma,and OCI via the angle measurement tool in the measure tab of minics.Results and Conclusion:The spatial distribution parameters of the RCPmi:In the coronal plane,it is located in the left 0?38.84 degrees to the posterior medial line,and in the right 0?39.19 degrees;the angle between the long axis and the vertical axis on the sagittal plane is 59.22 degrees;In the horizontal plane,when the dorsal wall of upper cervical dura mater was the apex,it is distributed in the range of 45.54?53.29 degrees(left is positive and right is negative).The spatial distribution parameters of the RCPma:In the coronal plane,it is located in the left 19.0?48.65 degrees to the posterior medial line,and in the right 12.57?38.37 degrees;the angle between the long axis and the vertical axis on the sagittal plane is 24.51 degrees;In the horizontal plane,when the dorsal wall of upper cervical dura mater was the apex,it is distributed in the range of 26.78?88.01 degrees in the right,and 26.40?84.14 degrees in the left.The spatial distribution parameters of the OCI:In the coronal plane,it is located in the left 48.65?70.03 degrees to the posterior medial line,and in the right 38.37?70.00 degrees;the angle between the long axis and the vertical axis on the sagittal plane is 45.24 degrees;In the horizontal plane,when the dorsal wall of upper cervical dura mater was the apex,it is distributed in the range of 88.01?129.49 degrees in the right,and 84.14?125.42 degrees in the left. |
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