Meningeal Layers Research Articles

Novel model of cortical–meningeal organoid co-culture system improves human cortical brain organoid cytoarchitecture

Human cortical organoids (hCOs), derived from human induced pluripotent stem cells (iPSCs), provide a platform to interrogate mechanisms of human brain development and diseases in complex three- dimensional tissues. However, current hCO development methods lack important non-neural tissues, such as the surrounding meningeal layer, that have been shown to be essential for normal corticogenesis and brain development. Here, we first generated hCOs from a single rosette to create more homogenous organoids with consistent size around 250 µm by day 5. We then took advantage of a 3D co-culture system to encapsulate brain organoids with a thin layer of meningeal cells from the very early stages of cortical development. Immunostaining analysis was performed to display different cortical layer markers during different stages of development. Real-time monitoring of organoid development using IncuCyte displayed enhanced morphology and increased growth rate over time. We found that meningeal-encapsulated organoids illustrated better laminar organization by exhibiting higher expression of REELIN by Cajal–Retzius neurons. Presence of meningeal cells resulted in a greater expansion of TBR2 intermediate progenitor cells (IPCs), the deep cortical layer (CTIP2) and upper cortical layer (BRN2). Finally, meningeal-encapsulated organoids enhanced outer radial glial and astrocyte formation illustrated by stronger expression of HOPX and GFAP markers, respectively. This study presents a novel 3D co-culture platform to more closely mimic the in vivo cortical brain structure and enable us to better investigating mechanisms underlying the neurodevelopmental disorders during embryonic development.

Anatomy and Histology of the Petrous Carotid Membrane: Application to Skull Base Surgery

Published reports regarding the tissue types that surround the internal carotid artery (ICA) as it travels through the carotid canal vary. Reports have variably defined this membrane as periosteum, loose areolar tissue, or dura mater. With such discrepancies and realizing that knowledge of this tissue might be important for skull base surgeons who expose or mobilize the ICA at this location, the present anatomical/histological study was performed. In 8 adult cadavers (16 sides), the contents of the carotid canal were evaluated; specifically, the membrane surrounding the petrous part of the ICA was studied, and its relationship to the deeper lying artery was observed. These specimens were stored in formalin and submitted for histological evaluation. Grossly, the membrane within the carotid canal traversed the entire carotid canal and was loosely adherent to the underlying petrous part of the ICA. Histologically, all membranes surrounding the petrous part of the ICA were consistent with dura mater. The dura mater of the carotid canal had an outer endosteal layer and an inner meningeal layer as well as a clear dural border cell layer in most specimens that approximated and was loosely applied to the adventitial layer of the petrous part of the ICA. The membrane that surrounds the petrous part of the ICA is dura mater. To our knowledge, this is the first histological investigation of this structure and thus serves to establish the true identity of this membrane and correct previous reports in the literature that have erroneously concluded that it is periosteum or loose areolar tissue.

The Oculomotor Cistern and Its Role in the Management of Pituitary Lesions: An Anatomical, Radiographic, and Clinical Scoping Review.

The oculomotor cistern (OMC) is a cerebrospinal fluid space bound by meningeal layers that surrounds the oculomotor nerve as it crosses the oculomotor triangle to reach the lateral wall of the cavernous sinus at the level of the anterior clinoid process. Although several anatomical and radiological studies are available, its anatomy and relationship with pituitary adenomas (PAs) are still matter of discussion. The aim of the study is to provide an updated and focused overview of the OMC, highlighting the different perspectives and descriptions from anatomical, radiological, and clinical points of view. A scoping review was conducted up to 29th October 2022, according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) criteria. PubMed, Web of Science, Scopus databases, and correlated citations were investigated. Of the 562 records identified, 22 were included in the present analysis. There were 13, 5, and 4 anatomo-surgical, radiological, and clinical studies, respectively. Though there is general consensus on its definition, data are variable on different features of OMC. Defects or absence of dural layers adjacent to the oculomotor nerve were described in only 4 papers. The transition from meningeal to neural layers is still unclear. PAs with OMC involvement are poorly studied and have unique clinical characteristics. To date, 21 patients have been described; the reported prevalence of OMC involvement by PAs ranges from 4.1% to 14.6%. Clarifying the OMC features with further systematic studies may not only broaden theoretical knowledge but also have implications on endoscopic transnasal pituitary surgery.

A mesothelium divides the subarachnoid space into functional compartments

The central nervous system is lined by meninges, classically known as dura, arachnoid, and pia mater. We show the existence of a fourth meningeal layer that compartmentalizes the subarachnoid space in the mouse and human brain, designated the subarachnoid lymphatic-like membrane (SLYM). SLYM is morpho- and immunophenotypically similar to the mesothelial membrane lining of peripheral organs and body cavities, and it encases blood vessels and harbors immune cells. Functionally, the close apposition of SLYM with the endothelial lining of the meningeal venous sinus permits direct exchange of small solutes between cerebrospinal fluid and venous blood, thus representing the mouse equivalent of the arachnoid granulations. The functional characterization of SLYM provides fundamental insights into brain immune barriers and fluid transport.

Distinct roles of the meningeal layers in CNS autoimmunity

The meninges, comprising the leptomeninges (pia and arachnoid layers) and the pachymeninx (dura layer), participate in central nervous system (CNS) autoimmunity, but their relative contributions remain unclear. Here we report on findings in animal models of CNS autoimmunity and in patients with multiple sclerosis, where, in acute and chronic disease, the leptomeninges were highly inflamed and showed structural changes, while the dura mater was only marginally affected. Although dural vessels were leakier than leptomeningeal vessels, effector T cells adhered more weakly to the dural endothelium. Furthermore, local antigen-presenting cells presented myelin and neuronal autoantigens less efficiently, and the activation of autoreactive T cells was lower in dural than leptomeningeal layers, preventing local inflammatory processes. Direct antigen application was required to evoke a local inflammatory response in the dura. Together, our data demonstrate an uneven involvement of the meningeal layers in CNS autoimmunity, in which effector T cell trafficking and activation are functionally confined to the leptomeninges, while the dura remains largely excluded from CNS autoimmune processes.

The endonasal midline inferior intercavernous approach to the cavernous sinus: technical note, cadaveric step-by-step illustration, and case presentation.

Traditional endoscopic endonasal approaches to the cavernous sinus (CS) open the anterior CS wall just medial to the internal carotid artery (ICA), posing risk of vascular injury. This work describes a potentially safer midline sellar entry point for accessing the CS utilizing its connection with the inferior intercavernous sinus (IICS) when anatomically present. The technique for the midline intercavernous dural access is described and depicted with cadaveric dissections and a clinical case. An endoscopic endonasal approach exposed the periosteal dural layer of anterior sella and CS. The IICS was opened sharply in midline through its periosteal layer. The feather knife was inserted and advanced laterally within the IICS toward the anterior CS wall, thereby gradually incising the periosteal layer of the IICS. The knife was turned superiorly then inferiorly in a vertical direction to open the anterior CS wall. This provided excellent access to the CS compartments, maintained the meningeal layer of the IICS and the medial CS wall, and avoided an initial dural incision immediately adjacent to the ICA. The midline intercavernous dural access to the CS assisted by a 90° dissector-blade is an effective modification to previously described techniques, with potentially lower risk to the ICA.

Basic principles of neuroimmunology.

The brain is an immune-privileged organ such that immune cell infiltration is highly regulated and better tolerating the introduction of antigen to reduce risk of harmful inflammation. Thus, the composition and the nature of the immune response is fundamentally different in the brain where avoiding immunopathology is prioritized compared to other peripheral organs. While the principle of immune privilege in the central nervous system (CNS) still holds true, the role of the immune system in the CNS has been revisited over the recent years. This redefining of immune privilege in the brain is a result of the recent re-discovery of the extensive CNS meningeal lymphatic system and the identification of resident T cells in the brain, meningeal layers, and its surrounding cerebrospinal fluid (CSF) in both humans and rodents. While neuro-immune interactions have been classically studied in the context of neuroinflammatory disease, recent works have also elucidated unconventional roles of immune-derived cytokines in neurological function, highlighting the many implications and potential of neuro-immune interactions. As a result, the study of neuro-immune interactions is becoming increasingly important in understanding both CNS homeostasis and disease. Here, we review the anatomically distinct immune compartments within the brain, the known mechanisms of leukocyte trafficking and infiltration into the CNS and unique transcriptional and functional characteristics of CNS-resident immune cells.

The effect of meninges on the electric fields in TES and TMS. Numerical modeling with adaptive mesh refinement

BackgroundWhen modeling transcranial electrical stimulation (TES) and transcranial magnetic stimulation (TMS) in the brain, the meninges – dura, arachnoid, and pia mater – are often neglected due to high computational costs. ObjectiveWe investigate the impact of the meningeal layers on the cortical electric field in TES and TMS while considering the headreco segmentation as the base model. MethodWe use T1/T2 MRI data from 16 subjects and apply the boundary element fast multipole method with adaptive mesh refinement, which enables us to accurately solve this problem and establish method convergence at reasonable computational cost. We compare electric fields in the presence and absence of various meninges for two brain areas (M1HAND and DLPFC) and for several distinct TES and TMS setups. ResultsMaximum electric fields in the cortex for focal TES consistently increase by approximately 30% on average when the meninges are present in the CSF volume. Their effect on the maximum field can be emulated by reducing the CSF conductivity from 1.65 S/m to approximately 0.85 S/m. In stark contrast to that, the TMS electric fields in the cortex are only weakly affected by the meningeal layers and slightly (∼6%) decrease on average when the meninges are included. ConclusionOur results quantify the influence of the meninges on the cortical TES and TMS electric fields. Both focal TES and TMS results are very consistent. The focal TES results are also in a good agreement with a prior relevant study. The solver and the mesh generator for the meningeal layers (compatible with SimNIBS) are available online.

Meningioma Cell Invasion into DuraGen-Derived Dura Mater: A Case Report

Background: Dura mater infiltration is the main growth pattern of meningiomas. Local recurrence may occur in any type of meningioma, but it is more likely so in atypical meningiomas. Therefore, a wide resection of tumor cell-invaded dura mater is necessary to avoid recurrence. DuraGen® (an artificial dural substitute) can be used for dural reconstruction in meningiomas. Here, we report a rare case of a patient with atypical meningioma that invaded into the DuraGen®-derived mature dura mater. Case presentation: A 66-year-old female showed a three-time recurrence of atypical meningioma. Simpson grade I resection (en bloc tumor with autologous dura mater and DuraGen®-derived dura mater resection) was achieved at the 3rd recurrence. Collagen fibers running regularly and transversely were observed in the DuraGen®-derived dura mater resembling the autologous meningeal layer. Meningioma cell invasion, displayed by occasional EMA immunostaining, was observed in the DuraGen®-derived dura mater. Conclusions: This case indicates that meningioma cells may invade and survive in the DuraGen®-derived dura mater. Whether or not DuraGen® is not appropriate as a dural substitute remains unanswered. Further experiences are needed to validate these findings in large sample sizes.

Optic nerve-associated connective tissue structures revisited: A histological study using human fetuses and adult cadavers.

Unlike the usual peripheral nerve, the optic nerve accompanies a thick "dural sheath," a thin "sheath of pia mater" (SPM), and multiple "septa," which divides the nerve fibers into fascicles. We collected specimens from 25 adult cadavers and 15 fetuses and revisited the histological architecture of the optic and oculomotor nerves. In the optic chiasma, the meningeal layer of the dura joins the pia to form a thick SPM, and the periosteum of the sphenoid is continuous with the dural sheath at the orbital exit of the bony optic canal. The septa appeared as a cluster of irregularly arrayed fibrous plates in the intracranial course near the chiasma. Thus, the septa were not derived from either the SPM or the dural sheath. In the orbit, the central artery of the retina accompanies collagenous fibers from the dural sheath and the SPM to provide the vascular sheath in the optic nerve. These connective tissue configurations were the same between adult and fetal specimens. At the optic disk, the dural sheath and SPM merged with the sclera, whereas the septa appeared to end at the lamina cribrosa. However, in fetuses without lamina cribrosa, the septa extend into the nerve fiber layer of the retina. The SPM and septa showed strong elastin immunoreactivity, in contrast to the absence of reactivity in the sheaths of the oculomotor nerve. Each S100 protein-positive Schwann sheath of the oculomotor nerve was surrounded by collagenous endoneurium. Glial fibrillary acidic protein-positive astrocytes showed a linear arrangement along the septa.

A CASE SERIES ON MENINGIOMA BASED ON WHO GRADING SYSTEM

Background:The dura mater, arachnoid mater and pia mater are layers of meninges surrounding brain and spinal cord. Meningiomas are tumors arising from them.These are heterogeneous group of tumors and are have 14 distinct histologic types and 03 grades of malignancy.We have studied the variants of meningiomas, as early detection helps in the treatment and improves quality of life. Objectives: -Study the histological types as per WHO grading system 2016 for meningiomas. -Differentiate the benign and malignant meningiomas on histopathology. Methods: The study is carried out in the department of pathology, D.Y. Patil medical college and hospital kolhapur from June 2020 to June 2021. Total 19 intracranial tumors were received. Sections were stained with H&E and IHC was done wherever necessary. Results:We had total 19 patients with tumors in different locations of brain. Mainly parasagital followed by intradural . Age range was 32 to 70 years with female predominance. Common histological subtypes were meningothelial (5 cases) and fibrous (5 cases), followed by transitional and angiomatous (2 cases each) and psamomatous (1 case) - WHO grade I tumors. Clear cell and atypical - grade II. Papillary, anaplastic variant - grade III. Conclusion: Meningiomas are slow growing tumors arising from the meningothelial cells. Commonly they are benign WHO grade I with female predominance. Early detection helps in the treatment and improves quality of life.

Not Just Blood: Brain Fluid Systems and Their Relevance to Cerebrovascular Diseases.

Not Just Blood: Brain Fluid Systems and Their Relevance to Cerebrovascular Diseases.

Constrictive Myelopathy in An Old Giant Dog

In pugs, West Highland white terriers and other small breeds, congenital or acquired malformations/deviations of the spine are commonly reported, resulting, amongst other complications, in chronic meningeal compression and fibrosis, and interference with cerebrospinal fluid flow into the sub-arachnoid space. This leads to constrictive myelopathy (CM) which involves the constriction and consequent reduced diameter of the spinal cord accompanied by parenchymal damage (mostly gliosis). A11-year-old giant mixed breed male dog presented with ataxia in the hindlimbs, paresis, reduced proprioception, and normal reflexes. Neurolocalization was to the thoracolumbar spinal cord (T3-L3). Myelographic computed tomography and magnetic resonance imaging (MRI) of this tract showed spondylosis, multiple disc protrusions with mild cord compression, and reduced spinal cord diameter. Genetic test for SOD1 mutations performed to evaluate predisposition to degenerative myelopathy negative results; although poorly compressive, the symptoms were attributed to multiple disc protrusions, leading to spinal cord atrophy. The dog underwent physiotherapy and 23 months later, was more ataxic and paretic however still ambulatory; repeated MRI confirmed the previous findings, however, the onset of concomitant megacolon and a chronic kidney failure, induced the owner to euthanasia. Histopathological assessment indicated diffused remodeling of the meninges with progressive constriction of the spinal cord of concomitant megacolon and a chronic kidney failure, induced the owner to euthanasia. Histopathological assessment indicated diffused remodeling of the meninges with progressive constriction of the spinal cord. Altered distribution of the mechanical forces among the meningeal layers with stiffening of the ventral pachymeninges, probably caused by the disc protrusions, was considered the most likely trigger. To our knowledge, this is the first case reporting clinical, MRI and histological findings resembling an acquired constrictive myelopathy in a large-breed dog.

Histomorphometry of mast cells in the convexity of human intracranial dura mater.

Mast cells, known as pro-inflammatory effector cells, are immunocytes present in the meninges and may be involved in the pathophysiology of migraine. This study aims to evaluate the histomorphometric parameters of mast cells located in the convexity of the human intracranial dura mater. For this, samples of intracranial dura mater from eight human fresh cadavers were collected between 8- and 24-h post-mortem. The whole samples were fixed and, subsequently, two fragments of 1.5cm² each were cut from four different areas of the dura mater convexity, containing a segment of the middle meningeal artery, totaling 64 fragments. After histological processing, the fragments were submitted to microtomy (5 and 10µm), stained with toluidine blue (0.1%), or immunohistochemically labeled for tryptase, and analyzed using optical microscopy. The following histomorphometric parameters were evaluated: distance from mast cells to vessels, the density of mast cells, and percentage of mast cells with degranulation. Histomorphometric analyzes showed a higher density of mast cells in the vicinity of blood vessels (arterial and venous), with distances around 0-150µm. A greater number of mast cells was detected near venous vessels in the periosteal layer (17.0±10.1cells/mm²) than in the meningeal layer (14.1±7.0cells/mm²) (p<0.05). Mast cells from the region close to the superior sagittal sinus were found in greater quantity close to the venous vessels (16.7±10.1cells/mm²) than to the arterial vessels (11.2±7.5cells/mm²) (p<0.05). In short, in the convexity of the human intracranial dura mater, mast cells are located close to blood vessels, with a greater number of cells next to the venous vessels of the periosteal layer and in the proximal region of the superior sagittal sinus.

Allografts for Skin Closure during In Utero Spina Bifida Repair in a Sheep Model.

Objectives: Use of off-label tissue graft materials, such as acellular dermal matrix (ADM), for in utero repair of severe spina bifida (SB), where primary skin layer closure is not possible, is associated with poor neurological outcomes. The cryopreserved human umbilical cord (HUC) patch has regenerative, anti-inflammatory, and anti-scarring properties, and provides watertight SB repair. We tested the hypothesis that the HUC is a superior skin patch to ADM for reducing inflammation at the repair site and preserving spinal cord function. Methods: In timed-pregnant ewes with twins, on gestational day (GD) 75, spina bifida was created without a myelotomy (functional model). On GD 95, repair was performed using HUC vs. ADM patches (randomly assigned) by suturing them to the skin edges. Additionally, full thickness skin closure as a primary skin closure (PSC) served as a positive control. Delivery was performed on GD 140, followed by blinded to treatment neurological assessments of the lambs using the Texas Spinal Cord Injury Scale (TSCIS) for gait, proprioception, and nociception. Lambs without spina bifida were used as controls (CTL). Ex vivo magnetic resonance imaging of spines at the repair site were performed, followed by quantitative pathological assessments. Histological assessments (blinded) included Masson’s trichrome, and immunofluorescence for myeloperoxidase (MPO; neutrophils) and for reactive astrocytes (inflammation) by co-staining vimentin and GFAP. Results: The combined hind limbs’ TSCIS was significantly higher in the HUC group than in ADM and PSC groups, p = 0.007. Both ADM and PSC groups exhibited loss of proprioception and mild to moderate ataxia compared to controls. MRI showed increased pathological findings in the PSC group when compared to the HUC group, p = 0.045. Histologically, the meningeal layer was thickened (inflammation) by 2–3 fold in ADM and PSC groups when compared to HUC and CTL groups, p = 0.01. There was lower MPO positive cells in the HUC group than in the ADM group, p = 0.018. Posterior column astrocyte activation was increased in ADM and PSC lambs compared to HUC lambs, p = 0.03. Conclusion: The HUC as a skin patch for in utero spina bifida repair preserves spinal cord function by reducing underlying inflammation when compared to ADM.

Evaluation of Rat Brain Morphology Following the Induction of Acute Meningitis Treated with Ceftriaxone.

The soft and delicate tissue of the brain, which is the center of our coordination, is protected by its surrounding layers. The disruption of these layers results in complicated situations and serious health problems. The brain has three protective layers of bone or skull tissue, the blood tissue layer, and finally the meningeal layer. The layer of blood tissue contains the blood vessels that are located between the skull and the meningeal membranes. If germs or foreign matter enter the fluid through the blood vessels under any circumstances and cause infection, the bones that protect the meninges will break and cause tissue damage. The present study aimed to assess the histological and immunohistochemical characteristics of the brain of rats that underwent induced acute purulent pneumococcal meningitis after antibiotic therapy with Ceftriaxone. A number of 20 white adult male Wistar rats were assigned to three groups. The first group (n=5) regarded as the control were injected with a saline solution into the subarachnoid space in an equivalent amount. The second and third groups of rats (n=5 and 10, respectively) were infected with acute purulent meningitis by the injection of 10 μl of Streptococcus pneumoniae (S. pneumonia) suspension into the subarachnoid space of the brain using a 23-G needle. The various areas of the brains of rats after meningitis inducedby S. pneumoniae were examined after the treatment with Ceftriaxone. The S. pneumoniae culture was injected into the subarachnoid space in the area of the rhomboid fossa. Treatment started 18 h after the injection. On day 10, a repeated puncture was performed with the analysis of cerebrospinal fluid in order to confirm the absence of meningitis; thereafter, the animals were taken out of the experiment. No signs of meningitis were found on histological examination. Mild perivascular and pericellular focal edema were revealed with signs of overload of the lymphatic system in the brain and focal ischemic changes in neurons. The investigation of expression with caspase-3 revealed a positive reaction of individual neurons. A positive reaction with antibodies to NeuN and Doublecortin was detected in most neurons; moreover, Glial fibrillary acidic protein (GFAP)-positive astrocytes and their processes were visualized in all layers of the brain substance. The reaction with neuron-specific enolase (NSE), microtubule-associated protein 2 (MAP-2), CD 31, and CD 34 was negative. Typical structure and pictures pointed to an intact brain and purulent meningitis in the first and second groups. The microscopic image and the changes revealed during immunohistochemistry by dual corticosteroid antibodies and neuronal nuclear protein were characterized by predominantly cytoplasmic and perinuclear reactions, respectively. Some neurons are positive for caspase-3 and are related to changes in the characteristic of premature aging.

Biomechanics of vascular areas of the human cranial dura mater

Accurate biomechanical properties of the human cranial dura mater are paramount for computational head models, artificial graft developments and biomechanical basic research. Yet, it is unclear whether areas of the dura containing meningeal vessels biomechanically differ from avascular areas. Here, 244 dura mater samples with or without vessels from 32 cadavers were tested in a quasi-static uniaxial tensile testing setup. The thicknesses of the meningeal and periosteal dura in vascular and avascular areas were histologically investigated in 36 samples using van Gieson staining. The elastic modulus of 112 MPa from dura samples containing vessels running transversely was significantly lower than samples with vessels running longitudinally (151 MPa; p < 0.001). The ultimate tensile strength of dura samples with transversely running vessels (11.1 MPa) was significantly lower in comparison to both avascular samples (14.9 MPa; p < 0.001) and samples with a longitudinally running vessel (15.0 MPa; p < 0.001). The maximum force of dura samples with longitudinally running vessels was 37 N (p < 0.001), this was significantly higher compared to the other groups which were 23 N (p < 0.001). The meningeal and periosteal dura layer thicknesses were not statistically different in avascular areas (p > 0.222). However, around the vessels, the meningeal dura layer was significantly thicker compared to the periosteal layer (p ≤ 0.019). The sum of the meningeal and periosteal layers was similar between vascular and avascular areas (p ≥ 0.071). Vascular areas of the human cranial dura mater withstand the same forces as avascular areas when being stretched. When stretched along the vessel, the dura-vessel composite can withstand even higher tensile forces compared to avascular areas. Vascular areas of the cranial dura mater seem to be similar when compared to avascular areas making their separate simulation in computational models non-essential.

Meningeal lymphatic endothelial cells fulfill scavenger endothelial cell function and cooperate with microglia in waste removal from the brain.

Brain lymphatic endothelial cells (BLECs) constitute a group of loosely connected endothelial cells that reside within the meningeal layer of the zebrafish brain without forming a vascular tubular system. BLECs have been shown to readily endocytose extracellular cargo molecules from the brain parenchyma, however, their functional relevance in relation to microglia remains enigmatic. We here compare their functional uptake efficiency for several macromolecules and bacterial components with microglia in a qualitative and quantitative manner in 5-day-old zebrafish embryos. We find BLECs to be significantly more effective in the uptake of proteins, polysaccharides and virus particles as compared to microglia, while larger particles like bacteria are only ingested by microglia but not by BLECs, implying a clear distribution of tasks between the two cell types in the brain area. In addition, we compare BLECs to the recently discovered scavenger endothelial cells (SECs) of the cardinal vein and find them to accept an identical set of substrate molecules. Our data identifies BLECs as the first brain-associated SEC population in vertebrates, and demonstrates that BLECs cooperate with microglia to remove particle waste from the brain.

Epidemiologic Evaluation of Central Nervous System Sarcomas in Iran: A 2009-2014 Survey

Sarcomas rise from mesenchymal layers and may transform to variable malignant lesions in multiple organs systems. Although they are mostly localized, many of them have predilection of distant sites away from their primary origins and subsequent metastasis to different anatomical locations of body. Soft Tissue Sarcomas (STSs) represent one percent of adult and about 7% of pediatric malignancies. Although insignificant in number, these tumors may complicate patient’s overall health status compared with other malignancies, because of their numerous subtypes and variable features which may pose an everlasting challenge to both clinical and surgical treatment strategies. Existence of these complications and a relatively small available data regarding Central Nervous System’s (CNS) sarcomas, encouraged authors to conduct a retrospective study in a 6-year period to evaluate the specific epidemiological features of CNS sarcomas, including brain, spinal cord and meningeal layer sarcomas extracted from Iranian National Cancer Registry (INCR). Our study revealed CNS sarcoma’s trend to affect males more than females, affecting them most in their midlife and a higher prevalence of brain involvement compared to spinal cord and meningeal layers. Also, we have provided detailed morphological features of the tumors, as well as patient’s geographical distribution, with Northern parts of Iran have the lowest incidence rate (10.06%). Moreover, our analysis of crude rate revealed lower Age Specific Incidence Rate (ASIR) of CNS Sarcomas than expected number of cases compared to standard world population by World Health Organization (WHO)’s ASIR as 0.035 person per 100000-years. Authors believe this report of epidemiological assessment of CNS sarcomas in Iran could act as a foundation for better understanding the underlying pathophysiological mechanism as it is the first survey in developing countries and selection of optimal treatment strategies based on improved understanding of these neoplasms.

Dissection‐Based Investigation of Variations in Major Gross Arterial Supply to the Trigeminal Ganglion

Introduction & Objective The trigeminal nerve (CN V) primarily conveys afferent sensory input from the anterolateral aspect of the face and scalp via its three main branches – the ophthalmic nerve (CN V1), maxillary nerve (CN V2), and mandibular nerve (CN V3). The 20,000-35,000 primary afferent pseudounipolar neurons of CN V1-3 converge at the trigeminal ganglion (TG) where the neurons’ cell bodies are positioned. The TG is located in Meckel's cave (cavum trigeminale), an intracranial area along the sphenoid bone deep to the meningeal layer of dura mater just anterior to the petrous apex. Four main arterial sources have been reported to perfuse the TG – the accessory meningeal artery (AMA), a branch of middle meningeal artery (MMA), a branch of internal carotid artery (ICA), and a tentorial branch of the superior cerebellar artery (SCA). The reported rate for each potential arterial supply remains variable. The objective of this study was to identify the arterial source of the TG via human cadaveric dissection and quantify the rate of occurrence. Materials & Methods Right and left trigeminal ganglia were examined on 29 embalmed human cadavers. Origins of gross arterial supply traversing the deep surface of the ganglia were identified and recorded. Arterial supply was photographed (iPad Pro, Apple Inc.) and image color contrast was utilized to aide structure identification (Adobe Photoshop 20.0.9). TG tissue samples including the major vessel(s) were collected, paraffin embedded, sectioned at 5 μm, and stained with hematoxylin and eosin (H&E). Major arteries and normal microvasculature were verified with light microscopy (Zeiss Axioskop, Model 45 14 85) and photographed (AmScope Digital Camera, Model MU1003). Results Blood supply to 28 TG was inconclusive due to compromised vessel integrity from a previous course dissection. Of the remaining 30 TG, 56.6% were supplied by a branch of ICA, 16.7% by AMA, and 10.0% by a branch of MMA. No TG were supplied by the tentorial branch of SCA. Anastomotic connections were discovered between MMA/ICA and AMA/ICA for 10.0% and 6.7% of TG supply, respectively. Three of the five AMAs were noted to course through separate foramen in the basicranium instead of the foramen ovale as expected. H&E histological examination confirmed artery structure and verified expected arteriole and capillary microvasculature throughout the TG. Conclusions & Significance In both exclusive and anastomotic form, the majority of TG arterial supply originated from the ICA. Supply from the AMA, MMA, and SCA occurred less often but still merit significance. The results of this study reflect known rates of TG arterial supply. Gross imaging from this study may supply medical educators with new resources to facilitate TG dissection in gross dissection laboratories and may also provide diagnosticians and cardiovascular surgeons with better understanding of TG arterial supply variations that could benefit diagnosis, surgical approaches, and outcomes. In case of blockage, stenosis, or ligation, anastomotic supply would provide anatomical insurance to the TG but warrants further study.