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REGIONAL ANESTHESIA

Ultrastructural Findings in Human Spinal Pia Mater in Relation to Subarachnoid Anesthesia

Miguel Angel Reina, MD^*,, Oscar De León Casasola, MD, M. C. Villanueva, MD, Andrés López, MD^*,, Fabiola Machés, MD, and José Antonio De Andrés, MD^||

*Department of Anesthesiology and Critical Care, Hospital General de Móstoles, Madrid, Spain; Department of Anesthesiology and Critical Care, Hospital Madrid Montepríncipe, Madrid, Spain; Department of Anesthesiology and Critical Care Medicine, Roswell Park Cancer Institute, Buffalo, New York; Department of Pathology, Hospital General de Móstoles, Madrid, Spain; and ||Department of Anesthesiology and Critical Care of Hospital General Universitario, Valencia, Spain

Address correspondence and reprint requests to Miguel Angel Reina, MD, Valmojado, 95 1°B, 28047, Madrid, Spain. Address e-mail to miguelangel.rei{at}terra.es

We examined ultrastructural details such as the cellular component and membrane thickness of human spinal pia mater with the aim of determining whether fenestrations are present. We hypothesized that pia mater is not a continuous membrane but, instead, that there are fenestrations across the pial cellular membrane. The lumbar dural sac from 7 fresh human cadavers was removed, and samples from lumbar spinal pia mater were studied by special staining techniques, immunohistochemistry, and transmission and scanning electron microscopy. A pial layer made by flat overlapping cells and subpial tissue was identified. We found fenestrations in samples from human spinal pia mater at the thoracic-lumbar junction, conus medullaris, and nerve root levels, but these fenestrations did not appear at the thoracic level. We speculate whether the presence of fenestrations in human spinal pia mater at the level of the lumbar spinal cord and at the nerve root levels has any influence on the transfer of local anesthetics across this membrane.

IMPLICATIONS: The ultrastructural anatomy of the human pia mater, such as pial cells, membrane thickness, and subpial tissue at different levels of the thoracic and lumbar spinal cord and nerve roots, was studied by special staining techniques, immunohistochemistry, and transmission and scanning electron microscopy. Fenestrations were found in samples at the thoracic-lumbar junction, conus medullaris, and nerve root levels. No fenestrations were found in samples at the thoracic level. At present, we cannot determine the significance of these findings.

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