Macroscopic Innervation of the Dura Mater Covering the Middle Cranial Fossa in Humans Correlated to Neurovascular Headache.

Shin-Hyo Lee,Wu-Chul Song,Sang-Don Han,Seung-Jun Hwang,Ki-Seok Koh

doi:10.3389/fnana.2017.00127

Shin-Hyo Lee, Wu-Chul Song + Show 3 more

Open Access

https://doi.org/10.3389/fnana.2017.00127

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Abstract

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. Forty-four sides of the cranial dura overlying the skull base obtained from 24 human cadavers were stained using Sihler’s method. 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 81.8% of cases (N = 36). Others did not form dominant nerve bundles, instead giving off free nerve endings along the course of the MMA or dural connective tissue. The distribution of these nerve endings was similar to that of the course of the frontal, parietal and petrosal branches of the MMA (11.4%). The others were not restricted to a perivascular plexus, crossing the dural connective tissues far from the MMA (6.8%). These findings indicate that the NS generally travels alongside the course of the frontal branches of the MMA and terminates in the vicinity of the pterion.

Highlights

Neuroanatomical studies have shown that the trigeminal nerve provides sensory innervation to the intracranial dura mater (O’Connor and van der Kooy, 1986; Strassman et al, 2004; Tomaszewska et al, 2015)
Nerve bundles of the nervus spinosus (NS) terminated at a confluence of the middle meningeal vein and the sphenoparietal sinus, and did not reach the region of the anterior cranial fossa (ACF) and distal frontal branches of the middle meningeal artery (MMA) in the temporal region (Figure 2)
The pathogenesis of migraine is a matter of ongoing discussion, but close relationships between activation of meningeal sensory fibers of the trigeminal nerve and dural vasodilation/vasoconstriction are thought to underlie the pain experienced in migraine (Kowacs et al, 2004; Strassman et al, 2004; Olesen et al, 2009)

Summary

Introduction

Neuroanatomical studies have shown that the trigeminal nerve provides sensory innervation to the intracranial dura mater (O’Connor and van der Kooy, 1986; Strassman et al, 2004; Tomaszewska et al, 2015). Activation of dural sensory fibers is regarded as pivotal for the generation of the pain experienced in some types of headaches, including migraine (May and Goadsby, 1999; Schueler et al, 2013). While there is still debate over the initiating events in migraine, it is widely believed that the headache pain could arise from activation of the trigeminovascular system in meningeal tissues so as to cause vasodilation (Shevel, 2009; Schueler et al, 2013).

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