Rapports méninges des nerfs spinaux dans leur trajet intra et extra foraminal : application en pratique chirurgicale

Abstract : Background: foraminal and extra foraminal spinal nerve sheath tumors are mainly schwanomma and represent about 30% of intraspinal primary tumors. The literature reports untill 14% of CSF leakage in the postoperative course. This complication increased morbidity in the perioperative period. Objective : the aim of this study is to define the anatomical relationships between the spinal nerves and the meningeal sheats in the intervertebral foramen at the cervical, thoracic and lumbar spinal levels thanks to a cadaveric anatomical study, to propose solutions to reduce and prevent the CSF leakage and to manage them in postoperative course. Material and Methods: the anatomical study was conducted on cadaveric bodies placed in a 10% formaldehyde solution obtained in the anatomy lab of the university of Bordeaux from the cadaveric donation. We reviewed the radiological exams of patient from the university hospital of Bordeaux (Neuro radiological department). Some dicoms data of Myelo MRI and CT were selected. We conducted an histological examination of the foraminal region of interest to complement the data. Results: The meninges was found to be strictly continuous with the nerve sheath. They are 3 possibilities for the dural limit layer : at the proximal part of the spinal ganglion with fibrous periosteal involvement, on the spinal ganglion itself with fibrous adhesion and after the spinal ganglion in continuity with the epineurium. The arachnoid sheath most often terminates by a pre ganglionic reticular recess. The mean distance between the entry of the FIV and the dorsal root ganglia is respectively 4,4mm, 3,8mm and 5,9mm at the cervical, thoracic and lumbar levels. Inter and intra individuals anatomic variations of the subarachnoid space are confirmed by the radiological finding. The histologic examination was biased by artefacts of bodies preservation. Conclusion: this anatomical study in addition to a literature review have clarified the meningeal sheath relationships of the spinal nerves into the intervertebral foramen. The exact anatomical conciderations of the tumor location: before, at the level or after the spinal ganglia allows us to consider the post operative risk of CSF leakage and the best surgical approach (posterior or extra foraminal approach). The postoperative risk of CSF leakage must be defined according to the anatomical and radiological characteristics find at the diagnostic.  
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Master Thesis
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Thomas Wavasseur. Rapports méninges des nerfs spinaux dans leur trajet intra et extra foraminal : application en pratique chirurgicale. Médecine humaine et pathologie. 2017. ⟨dumas-01623489⟩

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