肌硬膜桥与脑脊液循环

Myodural bridge and cerebrospinal fluid circulation

Hack于1995年首次提出肌硬膜桥的概念,即枕下头后小直肌、寰枕后膜与硬脊膜之间存在的致密纤维连接。随后的研究显示,来自于枕下头后大直肌、头下斜肌以及项韧带的纤维均参与形成肌硬膜桥。众多学者认为肌硬膜桥可能具有重要的功能,推测可能功能包括:(1)防止硬脊膜打折,保证小脑延髓池的畅通和脑脊液的正常流动;(2)传递本体感觉,调整头部位置;(3)与颈源性头痛有一定关联等。本课题组基于前期肌硬膜桥的形态学研究,提出肌硬膜桥是脑脊液循环动力来源之一的假说,并通过形态学、影像学等多种手段发现大量支持此假说的证据。肌硬膜桥是一个具有重要生理功能的结构,进一步深入研究其参与脑脊液循环的机制具有重要的临床意义,可能为临床疾病如慢性不明原因头痛提供新的诊疗思路。

The concept of MDB was first proposed by Hack in 1995. The dense fibrous connective tissues between the Rectus Capitis Posterior minor（RCPmi） and the Posterior Atlanto-Occipital Membrane（PAO membrane）,the PAO membrane and the cervical spinal dura mater（SDM） in the suboccipital region are named as Myodural Bridge（MDB）.Subsequent studies have revealed that fibers originating from Rectus Capitis Posterior major（RCPma）,Oblique Capitis Inferior（OCI） and nuchal ligament in the suboccipital region all participate in the formation of the MDB. Multiple researchers infer that MDB might have important functions that the MDB might has implications in avoiding in-folding of spinal dura mater and keeping the subarachnoid space and the cerebellomedullary cistern unobstructed,sensorimotor function and postural control of head,in cervicocephalic pain syndromes. Sui et al. proposed that the motion of the suboccipital muscles may be a dynamic source for the Cerebro Spinal Fluid（CSF） circulation via the MDB. Then they found multiple evidences to support the hypothesis though morphology and radiology methods. MDB is a structure having important physiological function. Further researches should be taken to find out the mechanism of MDB involving in the CSF circulation. It may provide new ideas and methods for the diagnosis and curing for the chronic headache of unknown cause.