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> Anatomy > Body Space or Junction > Subarachnoid Space

Subarachnoid Space

The subarachnoid space is the fluid-filled area between the arachnoid mater and the pia mater, two of the three membranes surrounding the brain and spinal cord.
This space contains cerebrospinal fluid that cushions and protects the central nervous system.
It is an important anatomical region for the study of neurological conditions and the delivery of therapeutic agents.
Researchers can optimize their protocols in the subarachnoid space using PubCompare.ai, an AI-driven platform that helps identify the best research methods from literature, preprints, and patents, ensuring reproducibility and accurayc.
This cutting-edge tool can enhance studies of the subarachnoid space by facilitating comparisons of effective products and techniques.

Most cited protocols related to «Subarachnoid Space»

1
Improving Cause of Death Data
Vital registration with medical certification of cause of death is a crucial resource for the GBD cause of death analysis in many countries. Cause of death data obtained using various revisions of the International Classification of Diseases and Injuries (ICD)9 were mapped to the GBD cause list. Many deaths, however, are assigned to causes that cannot be the underlying cause of death (eg, cardiopulmonary failure) or are inadequately specified (eg, injury from undetermined intent). These deaths were reassigned to the most probable underlying causes of death as part of the data processing for GBD. Redistribution algorithms can be divided into three categories: proportionate redistribution, fixed proportion redistribution based on published studies or expert judgment, or statistical algorithms. For GBD 2019, data for 116 million deaths attributed to multiple causes were analysed to produce more empirical redistribution algorithms for sepsis,10 (link) heart failure, pulmonary embolism, acute kidney injury, hepatic failure, acute respiratory failure, pneumonitis, and five intermediate causes (hydrocephalus, toxic encephalopathy, compression of brain, encephalopathy, and cerebral oedema) in the central nervous system. To redistribute unspecified injuries, we used a method similar to that of intermediate cause redistribution, using the pattern of the nature of injury codes in the causal chain where the ICD codes X59 (“exposure to unspecified factor”) and Y34 (“unspecified event, undetermined intent”) and GBD injury causes were the underlying cause of death. These new algorithms led to important changes in the causes to which these intermediate outcomes were redistributed. Additionally, data on deaths from diabetes and stroke lack the detail on subtype in many countries; we ran regressions on vital registration data with at least 50% of deaths coded specifically to type 1 or 2 diabetes and ischaemic, haemorrhagic, or subarachnoid stroke to predict deaths by these subtypes when these were coded to unspecified diabetes or stroke.
Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. (2020). Lancet (London, England), 396(10258), 1204-1222.
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Publication 2020
Brain Central Nervous System Cerebral Edema Cerebrovascular Accident Congestive Heart Failure Diabetes Mellitus Encephalopathies Encephalopathy, Toxic Hemorrhage Hepatic Insufficiency Hydrocephalus Injuries Kidney Injury, Acute Pneumonitis Pulmonary Embolism Respiratory Failure Septicemia Subarachnoid Space
2
Watershed Principle for Brain Extraction

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Publication 2011
Acquired Immunodeficiency Syndrome Brain Cerebrospinal Fluid Subarachnoid Space White Matter
3
Diagnostic Criteria for Idiopathic Normal Pressure Hydrocephalus
The candidates for this study were patients with suspected iNPH. After obtaining written informed consent, the eligible patients were pre-registered and received lumbar puncture. The inclusion criteria were (1) age between 60 and 85 years, (2) presence of one or more symptom(s) of the triad (gait disturbance, cognitive impairment, and urinary symptoms), which were measurable on the iNPH Grading Scale (iNPHGS) [14 (link)], (3) MRI features of iNPH, i.e., both ventriculomegaly of Evans' index > 0.3 and tight high-convexity and medial subarachnoid spaces on coronal T1-weighted MRI (Figure 1) [10 (link)], (4) absence of known disorders causing ventriculomegaly, and (5) normal cerebrospinal fluid (CSF) content (protein ≤ 50 mg/dl and cell count ≤ 3 μm3) and pressure (≤ 20 cmH2O). Exclusion criteria were (1) presence of musculoskeletal, cardiopulmonary, renal, hepatic, or mental disorders that would make it difficult to evaluate changes of symptoms, (2) obstacles to one-year follow-up, and (3) hemorrhagic diathesis or anticoagulant medication. For the evaluation of the MRIs, Evans' index, size of the Sylvian fissures rated according to the protocol of Kitagaki et al. [10 (link)], presence or absence of focal dilatation of the cerebral sulci, and white-matter changes according to scale of Fazekas et al. [15 (link)], were assessed on each site and recorded.
The candidates were pre-registered before CSF examination via a web-based case report system. MRI was reviewed by each site in the pre-registration phase, and the final eligibility of the subjects was judged by the central MRI review committee, which consist of neurosurgeons, neurologists, and a neuroradiologist. The central MRI review committee excluded those whose MRI did not fulfil the inclusion criteria. After the confirmation of normal CSF content and pressure, the investigator was notified of registration via the web system. Tap test was carried out in all subjects with 30 ml CSF removal via lumbar puncture. CT cisternography was carried out 1 week after the tap test with iohexol (Omnipaque®: 180 mg/ml) 30 mg/kg. Cerebral blood flow was measured using 123I-Iodoamphetamine and single photon emission computed tomography at baseline. However, the results of these measures were not considered for the eligibility.
Hashimoto M., Ishikawa M., Mori E, & Kuwana N. (2010). Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal Fluid Research, 7, 18.
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Publication 2010
Anticoagulants Cerebrospinal Fluid Cerebrovascular Circulation Dilatation Disorders, Cognitive Eligibility Determination Hemorrhagic Disorders Iodine-123 Iohexol Kidney Mental Disorders Neurologists Neurosurgeon Omnipaque Patients Pressure Proteins Punctures, Lumbar Subarachnoid Space Tomography, Emission-Computed, Single-Photon Triad resin Urine White Matter
4
Longitudinal Study of Stroke Recovery
A sample of 120 persons with a first occurrence of stroke will be included and followed longitudinally for one year after the stroke. The group will consist of consecutively included persons recruited from the stroke unit at Sahlgrenska University Hospital, Gothenburg, Sweden. The Stroke unit at Sahlgrenska University Hospital serves the larger Gothenburg urban area, thus all persons from this catchment area are randomly referred to the Sahlgrenska University Hospital. The project is approved by the Regional Ethical Review Board and the Helsinki declaration is followed. Written informed consent will be obtained from the participants or from their closest relative. The SALGOT study is registered on ClinicalTrials.gov (NCT01115348).
Inclusion criteria are:
• Diagnosed first ever clinical stroke, based on WHO criteria (ischemic infarct, haemorrhagic and subarachnoidal bleeding)
• Impaired upper extremity function. This is defined in two steps. On the first or second day after stroke onset the upper extremity function is assessed with Modified Motor Assessment Scale (M-MAS UAS-95) [33 ] (this is performed as standard clinical assessment by physiotherapists working at the stroke unit). All persons, who do not obtain the maximum score on the subtests of arm function, hand movements and fine motor function due to hemiparesis, will be informed about the study and retested at day three after stroke with Action Research Arm Test (ARAT) [34 (link)]. All persons who do not achieve the maximum score for ARAT (score 57) will be included.
• Admitted to the stroke unit within three days after stroke onset
• Living in the Gothenburg urban area (maximal 35 km from the Sahlgrenska University Hospital)
• Age 18 or older
Exclusion criteria are:
• Upper-extremity injury or condition prior to the stroke that limits the functional use of the affected arm and hand
• Severe multi-impairment or diminished physical condition before the stroke that will affect the arm function
• Life expectancy less than 12 months due to other illness (cardiac disease, malignancy) or severity of stroke injury
• Not Swedish speaking prior to the stroke incident
Alt Murphy M., Persson H.C., Danielsson A., Broeren J., Lundgren-Nilsson Å, & Sunnerhagen K.S. (2011). SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol. BMC Neurology, 11, 56.
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Publication 2011
Arm Injuries Cerebrovascular Accident Ethical Review Heart Diseases Hemiparesis Infarction Injuries Malignant Neoplasms Movement Physical Examination Physical Therapist Subarachnoid Space Upper Extremity
5
Ascertainment of Incident Stroke Subtypes
The outcome was the first occurrence of stroke, either the first nonfatal stroke event, or stroke death. Ascertainment of incident stroke was described previously18 (link), 19 . Briefly, all participants were linked to the Municipal Social Insurance Institution database and the hospitals’ discharge register for incidence of stroke, which cover all the Kailuan study participants. We used the International Classification of Diseases (ICD, I63 for cerebral infarction and I61 for intracerebral hemorrhage), Tenth Revision, for the identification of potential stroke cases. Additional, information regarding past medical history of stroke was collected via questionnaire biennially since 2006. Deaths were collected from local vital statistics offices. For potential stroke cases identified by the ICD code and/or questionnaire, a panel of 3 physicians reviewed their medical records. Nonfatal strokes were defined as the sudden onset of focal neurological deficit with vascular mechanism lasting >24 hours. Fatal strokes were confirmed by medical records, autopsy reports and death certificates with stroke listed as the underlying cause. Stroke was diagnosed according to the World Health Organization criteria21 combined with a brain computed tomography or magnetic resonance imaging for confirmation. In the current study, we included only 2 main stroke subtypes: intracerebral hemorrhage (not included subarachnoid and subdural hemorrhages) and cerebral infarction.
Assessment of potential confounders was detailed in Data Supplement Methods S2
Li W., Jin C., Vaidya A., Wu Y., Rexrode K., Zheng X., Gurol M.E., Ma C., Wu S, & Gao X. (2017). Blood Pressure Trajectories and the Risk of Intracerebral Hemorrhage and Cerebral Infarction: a Prospective Study. Hypertension (Dallas, Tex. : 1979), 70(3), 508-514.
Publication 2017
Autopsy Blood Vessel Brain Cerebral Hemorrhage Cerebral Infarction Cerebrovascular Accident Dietary Supplements Hematoma, Subdural Patient Discharge Physicians Subarachnoid Space X-Ray Computed Tomography

Most recents protocols related to «Subarachnoid Space»

1
Characterizing Idiopathic Normal Pressure Hydrocephalus
The study design and protocol have been approved by the ethics committees for human research at our institute (IRB number: R2019-227). This study followed a prospective and observational design. The study was performed in accordance with the approved guidelines of the Declaration of Helsinki. From November 2020 to February 2022, 133 healthy volunteers aged ≥ 20 years underwent MRI after providing written informed consent explaining the potential for detection of brain disease. Volunteers were recruited from medical staff and students, and their families by open recruitment. Inclusion criteria for this study were those who had no history of brain injury, brain tumor or cerebrovascular disease on previous brain MRI, or those who had never undergone brain MRI and no neurological symptoms including cognitive function. One volunteer aged 84 years old was excluded from this study because of a history of head surgery due to a head injury over 30 years ago. In addition, three volunteers were incidentally found small unruptured intracranial aneurysms with a maximum diameter of < 2 mm on this MRI. They were included in this study, because small unruptured aneurysms might not affect CSF motion.
Patients’ MRI data was used in an opt-out method, after their personal information was anonymized in a linkable manner. Among 44 patients suspected with NPH, 5 patients diagnosed with secondary NPH [29 (link)] that developed after subarachnoid hemorrhage [3 (link)], intracerebral hemorrhage [1 (link)], and severe meningitis [1 (link)], and 3 patients diagnosed with congenital/developmental etiology NPH [30 (link)] were excluded from this study. Finally, 36 patients diagnosed with iNPH who had radiological findings of disproportionately enlarged subarachnoid space hydrocephalus (DESH) [31 (link)], specifically ventricular dilatation, enlarged Sylvian fissure, and narrow sulci at the high convexity, and triad symptoms of gait disturbance, cognitive impairment, and/or urinary incontinence were included in this study, according to the Japanese guidelines for management of iNPH [32 (link)]. Of them, 18 patients (50%) underwent CSF removal in 30–35 ml via a lumbar tap and were evaluated for changes in their symptoms before, one day and two days after the CSF tap test. In addition, 21 patients (86%) underwent CSF shunt surgery and their symptoms improved by ≥ 1 point on the modified Rankin Scale and/or the Japanese iNPH grading scale [32 (link)].
Yamada S., Hiratsuka S., Otani T., Ii S., Wada S., Oshima M., Nozaki K, & Watanabe Y. (2023). Usefulness of intravoxel incoherent motion MRI for visualizing slow cerebrospinal fluid motion. Fluids and Barriers of the CNS, 20, 16.
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Publication 2023
Aneurysm Brain Brain Diseases Brain Injuries Brain Neoplasms Cerebral Hemorrhage Cognition Craniocerebral Trauma Dilatation Disorders, Cognitive Ethics Committees Head Healthy Volunteers Heart Ventricle Homo sapiens Hydrocephalus Intracranial Aneurysm Japanese Lumbar Region Medical Staff Meningitis Neurologic Symptoms Operative Surgical Procedures Patients Shunt, Cerebrospinal Fluid Student Subarachnoid Hemorrhage Subarachnoid Space Triad resin Urinary Incontinence Voluntary Workers X-Rays, Diagnostic
2
Standardized Anesthesia and Multimodal Analgesia Protocols
In Yuan et al study,[29 (link)] patients received standardized general anesthesia and basic analgesic protocol. Intraoperatively, all patients received general anesthesia which was induced by sufentanil 0.5 μg/kg, midazolam 0.04 mg/kg, propofol 1 to 2 mg/kg, and Cisatracurium 2 μg/kg intravenously, followed by continuous intravenous infusion of remifentanil 0.1 to 0.3 μg/(kg·min), propofol 2 to 5 mg/(kg·hr) and inhalation of sevoflurane to maintain anesthesia. Since postoperative day 1, the protocol of oral celecoxib restarted till postoperative 3 weeks when the patients came back to the hospital for taking out the stitches. In Yadeau et al 2016 study,[6 (link)] patients received a standardized anesthetic and multimodal analgesic protocol. In Yadeau et al 2022 study,[28 (link)] patients received a standard intraoperative and postoperative multimodal anesthetic protocol: a spinal-epidural (subarachnoid mepivacaine, 45–60 mg); adductor canal block (ultrasound-guided; 15 cc bupivacaine, 0.25%, with 2 mg preservative-free dexamethasone). For postoperative pain management, patients were scheduled to receive the study medication once daily for 14 days; 4 doses of 1000 mg IV acetaminophen every 6 hours followed by 1000 mg oral acetaminophen every 8 hours; 4 doses of 15 mg IV ketorolac followed by 15 mg meloxicam every 24 hours; and 5 to 10 mg oral oxycodone was given as needed for pain. Patients could have pain medications adjusted as indicated. In Koh et al study,[12 (link)] all patients had a postoperative intravenous patient-controlled anesthesia (PCA) pump that administered 1 mL of a 100-mL mixture containing 2000 mg of fentanyl on demand. In Kim et al study,[27 ] all patients received intravenous PCA encompassing delivery of 1 mL of a 100 mL solution containing 2000 µg of fentanyl postoperatively. In Ho et al study,[26 (link)] patients were routinely offered a single shot spinal anesthesia consisting of an intrathecal dose of bupivacaine 10 to 12.5 mg with fentanyl 10 mg. After surgery, pain treatment consisted of PCA with intravenous injection of morphine. The settings were 1 mg bolus, 5 minutes lockout time, and a maximum hourly limit of 8 mg. All patients were also given acetaminophen 1 g 6 hourly.
Zhang L.K., Li Q., Fang Y.F, & Qi J.W. (2023). Effect of duloxetine on pain relief after total knee arthroplasty: A meta-analysis of randomized controlled trials. Medicine, 102(10), e33101.
Publication 2023
Acetaminophen Analgesics Anesthesia Anesthesia, Intravenous Anesthetics Bupivacaine Cardiac Arrest Celecoxib cisatracurium Dexamethasone Fentanyl General Anesthesia Inhalation Intravenous Infusion Ketorolac Management, Pain Meloxicam Mepivacaine Midazolam Morphine Multimodal Imaging Obstetric Delivery Operative Surgical Procedures Oxycodone Pain Pain, Postoperative Patients Pharmaceutical Preparations Pharmaceutical Preservatives Propofol Pulp Canals Remifentanil Sevoflurane Spinal Anesthesia Subarachnoid Space Sufentanil Ultrasonography
3
Humanoid Robot-led Neurorehabilitation for Stroke Survivors
The participants for this study could be stroke survivors who participated in the clinical trial E-BRAiN (Evidence-based Robot Assistant in Neurorehabilitation; https://clinicaltrials.gov/ct2/show/NCT05152433) and completed the 2-week course of the humanoid robot-led therapy at one of the two study centres, i.e., the Universitätsmedizin Greifswald or the BDH-Klinik Greifswald. The eligibility criteria for the E-BRAiN trial were as follows: age ≥18 years, history of stroke (ischaemic stroke, non-traumatic intracerebral haemorrhage, and subarachnoidal haemorrhage), either stroke-related upper extremity paresis or visual neglect, not pregnant or breastfeeding, not living in custody, and providing informed consent.
The research was approved by the institution’s review board (Ethikkommission der Universitätsmedizin Greifswald; date of approval: 10.05.2021).
Platz T., Pedersen A.L, & Bobe S. (2023). Feasibility, coverage, and inter-rater reliability of the assessment of therapeutic interaction by a humanoid robot providing arm rehabilitation to stroke survivors using the instrument THER-I-ACT. Frontiers in Robotics and AI, 10, 1091283.
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Publication 2023
Brain Cerebrovascular Accident Eligibility Determination Ethics Committees, Research Hemorrhage Neurological Rehabilitation Stroke, Ischemic Subarachnoid Space Survivors Therapeutics Traumatic Cerebral Hemorrhage Upper Extremity Paresis
4
Awake Brain Tumor Resection Protocol
As previously described (11 (link)), the critical points of awake surgery include patient position, awake anesthesia, neuronavigation, intraoperative ultrasound, DES mapping, and tumor resection. All patients were anesthetized by administration of propofol and remifentanil by target-controlled infusion, using a laryngeal mask airway for intubation during the craniotomy. The ipsilateral critical sensory scalp nerves, pin insertion, and scalp incision sites were injected with local anesthetic (0.67% lidocaine and 0.33% ropivacaine) with 1:200,000 adrenaline to provide rapid and long-lasting local anesthesia while reducing bleeding. Anesthesia was withdrawn to wake up the patient. The location of the tumor was detected intraoperatively using ultrasound before brain mapping and tumor resection. DES mapping was performed using a 5-mm interval bipolar electrical nerve stimulator (Osiris NeuroStimulator; inomed Medizintechnik GmbH, Emmendingen, Germany) with a frequency of 60 Hz, a pulse duration of 1 ms, a current of 2–6 mA (usually 3–4 mA), and a duration of 1 s for motor and sensory tasks and 4 s for language or other cognitive tasks. Positive motor area stimulation was assumed when movements of the contralateral limb or face were induced. Positive stimulation affecting sensory areas was considered when an abnormal feeling was generated in the contralateral limb or face. Positive stimulation of language areas was considered when the patient exhibited counting arrest, anomia, speech repetition, or other language disturbances without twitching of the mouth. After cortical mapping, the lesion was removed by alternating resection and regular subcortical stimulation.
To protect functional pathways, the patient was asked to continue to move their arm and hand or leg, count numbers, or name pictures when the resection moved closer to the subcortical structures. If the patient experienced weakness of the limb, abnormal language, or abnormal sensation, subcortical DES was performed immediately with the same stimulation parameters. If the above-mentioned positive reaction occurred, it was confirmed to be an essential subcortical conduction pathway. The resection was then interrupted in this direction and was continued in other directions. If no positive response occurred, after the patient’s function recovered, resection was continued until the subcortical areas (positive stimulation) or normal meninges (such as the falx cerebri, fissures), ventricles, or arachnoid borders were encountered, or when more than 1 cm outside of normal white matter surrounding the tumor could be visualized. Tumors were resected 2 mm from the sulci near the eloquent brain areas and then were resected inside the pia mater to avoid damage to the vital supplying arteries in the subarachnoid space. Lesions were safely removed to the greatest extent possible to preserve the cortical and subcortical structures of critical functional areas, drainage veins, and supplying arteries.
Yao S., Yang R., Du C., Jiang C., Wang Y., Peng C, & Bai H. (2023). Maximal safe resection of diffuse lower grade gliomas primarily within central lobe using cortical/subcortical direct electrical stimulation under awake craniotomy. Frontiers in Oncology, 13, 1089139.
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Publication 2023
Anesthesia Anomia Arachnoid Maters Arteries Asthenia Brain Cognition Cortex, Cerebral Craniotomy Drainage Electric Conductivity Electricity Epinephrine Face Falx Cerebri Heart Ventricle Intubation Laryngeal Masks Lidocaine Local Anesthesia Meninges Motor Cortex Movement Neoplasms Neoplasms by Site Nervousness Neuronavigation Operative Surgical Procedures Oral Cavity Paresthesia Patients Pia Mater Propofol Pulse Rate Remifentanil Ropivacaine Scalp Speech Subarachnoid Space Ultrasonography Veins White Matter
5
Thoracic Epidural Analgesia Protocol
In a lateral decubitus position, the interlaminar space between the 6th and 7th thoracic vertebrae was identified using ultrasound by counting ribs and TPs of thoracic vertebrae downward from the first rib. The patient underwent skin disinfection and received a block, and an 18G Tuohy needle (Perifix® Soft Tip 700 Filter Set; B. Braun, Melsungen, Germany) was inserted via a paramedian approach. Using the loss-of-resistance approach, the epidural space was detected, and a multi-orifice catheter was placed around 3 cm beyond the needle’s tip. After measuring the location of the catheter tip using fluoroscopy with a contrast agent, a test dose of 3 mL 2% lidocaine with 15 µg epinephrine was administered to ensure that the catheter was not in the subarachnoid space or epidural vein. A loading dose of 6 mL 0.375% ropivacaine was administered 30 minutes before the end of surgery. A PCA system was used to deliver 0.2% ropivacaine (Accumate 1200; Woo Young Medical, Seoul, Korea; 250 mL 0.2% ropivacaine, background infusion rate 3 mL/hour (h), bolus volume 3 mL, lock-out interval 20 minutes) for 2 postoperative days.
Hong J.M., Kim E., Jeon S., Lee D., Baik J., Cho A.R., Cho J.S, & Ahn H.Y. (2023). A prospective double-blinded randomized control trial comparing erector spinae plane block to thoracic epidural analgesia for postoperative pain in video-assisted thoracic surgery. Saudi Medical Journal, 44(2), 155-163.
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Publication 2023
Catheters Contrast Media Disinfection Epinephrine Fluoroscopy Lidocaine Needles Operative Surgical Procedures Patients Ropivacaine Skin Spaces, Epidural Strains Subarachnoid Space Ultrasonography Veins Vertebrae, Thoracic

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More about "Subarachnoid Space"

The Subarachnoid Space: A Critical Realm for Neurological Research and Therapeutic Delivery The subarachnoid space, also known as the arachnoid space, is a crucial anatomical region situated between the arachnoid mater and the pia mater, two of the three membranes surrounding the brain and spinal cord.
This fluid-filled area is home to the cerebrospinal fluid (CSF), which plays a vital role in cushioning and protecting the central nervous system (CNS).
Researchers have long recognized the significance of the subarachnoid space in the study of neurological conditions and the delivery of therapeutic agents.
This specialized region offers a unique opportunity to optimize research protocols and enhance understanding of various neurological disorders.
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