Citation, DOI & article data
The dura mater, also known as the pachymeninx (plural: pachymeninges), is the tough outer layer of the meninges that surrounds the central nervous system and is pierced by the cranial nerves, the internal carotid arteries, and the vertebral arteries.
Intracranially, it is formed by two layers:
- outer endosteal layer, continuous via the skull sutures and foramina with the periosteum
- inner meningeal layer, continuous inferiorly with the theca of the spinal cord
As the outer layer is merely the periosteum, it surrounds the cranial bones and therefore extends into the sutures making the dura inseparable from these and thus limiting extradural hemorrhages to the sutures.
With age, the dura becomes thicker and more adherent to the overlying bones, accounting for the lower incidence of extradural hemorrhages in the elderly.
The inner layer requires little nourishment. Whereas the outer layer is markedly vascular and derives its blood supply from the adherent bone. Arterial supply is therefore dependent on the site of the dura:
- anterior cranial fossa
middle cranial fossa
- middle meningeal artery is the major supply (a branch of the maxillary artery and has anterior and posterior divisions)
- accessory meningeal arteries (branches from the maxillary artery)
- the dura over the cavernous sinuses is supplied by small meningeal branches of the internal carotid and accessory meningeal arteries
- posterior cranial fossa: various blood supply including
All these vessels course between the two layers of the dura.
Until 2015 it was thought that the meninges lacked their own lymphatic drainage system, but since the groundbreaking work by Antoine Louveau et al, the details are gradually being teased out, although the precise anatomy of the meningeal lymphatic drainage system remains incomplete 6,7.
Like the arterial supply, innervation is dependent on the site of the dura:
- the dominant nerve supplying most of the supratentorial dura is the tentorial nerve (a branch of the ophthalmic nerve (CN Va) which supplies the falx cerebri, calvarial dura and superior surface of the tentorium cerebelli.
- anterior cranial fossa
- anterior meningeal branches from the ethmoidal nerves (CN Va)
- meningeal branches from the maxillary nerve (CN Vb)
- middle cranial fossa
- posterior cranial fossa
- sensory branches from the vagus nerve (CN X) and glossopharyngeal nerve (CN IX) supply the inferior surface of the tentorium and dura of the posterior fossa
- small sensory branches of the C1 to C3 dorsal rami supply around the foramen magnum (this is explained embryologically by the upward migration of spinal dura to invest the brain)
History and etymology
"Dura mater" derives from the medieval Latin "durus" and "mater", i.e. "hard mother". This term was created by the Italian scholar, Stephen of Antioch (fl. 12th century) when he translated work by the Persian physician Haly Abbas in the 12th century 2,8. Islamic medicine at that time conjectured that the meninges gave rise to all the membranes of the body and expressed relationships between different tissue types in terms of familial relationships (mother, son, daughter, etc.).
- 1. DSc SSP. Gray's anatomy. Churchill Livingstone. (2005) ISBN:0443071683. Read it at Google Books - Find it at Amazon
- 2. Skinner HA. Origin of Medical Terms. Hafner Publishing Co Ltd. ISBN:0028523903. Read it at Google Books - Find it at Amazon
- 3. Moore KL, Agur AMR, Dalley AF. Clinically oriented anatomy. LWW. ISBN:1451119453. Read it at Google Books - Find it at Amazon
- 4. Last's anatomy, regional and applied. Churchill Livingstone. ISBN:044304662X. Read it at Google Books - Find it at Amazon
- 5. Butler P, Mitchell A, Healy JC. Applied Radiological Anatomy. Cambridge University Press. (2012) ISBN:0521766664. Read it at Google Books - Find it at Amazon
- 6. Louveau A, Smirnov I, Keyes TJ, Eccles JD, Rouhani SJ, Peske JD, Derecki NC, Castle D, Mandell JW, Lee KS, Harris TH, Kipnis J. Structural and functional features of central nervous system lymphatic vessels. (2015) Nature. 523 (7560): 337-41. doi:10.1038/nature14432 - Pubmed
- 7. Dupont G, Schmidt C, Yilmaz E, Oskouian RJ, Macchi V, de Caro R, Tubbs RS. Our current understanding of the lymphatics of the brain and spinal cord. (2019) Clinical anatomy (New York, N.Y.). 32 (1): 117-121. doi:10.1002/ca.23308 - Pubmed
- 8. Dirk Grupe. Stephen of Pisa and Antioch. (2019) ISBN: 9783030192341