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Chapter 5. Ultrastructural Anatomy of the Spinal Meninges and Related Structures

Which of the following statements is most accurate regarding dural puncture?

A. The size of the lesion created by a 24-gauge spinal needle is similar with both the pencil-point and cutting-needle designs.

B. Cutting needles produce a greater and rougher-appearing injury to dural fibers as compared to pencil-point needles.

C. Sagittal bevel orientation of a cutting spinal needle is less likely to produce postdural puncture headache (PDPH) as compared to a transverse orientation.

D. The morphology of dural lesions is consistent between different spinal needle designs.

A is correct. The size of the lesion created by a 24-gauge spinal needle is similar with the pencil-point and cutting-needle designs.

B is incorrect. Pencil-point needles produce a greater and rougher-appearing injury to dural fibers as compared to cutting needles.

C is incorrect. Bevel orientation does not affect the size or morphology of lesions when using cutting needles.

D is incorrect. The morphology of dural lesions is dependent on the design of needle tip.

A 23-year-old primigravid patient for cesarean delivery receives a spinal anesthetic with a 24-gauge cutting needle. Which of the following mechanical factors is true regarding her spinal puncture?

A. Passing a needle into the dural sac creates a lesion in the dura mater while sparing the arachnoid layer.

B. The dural layer will take at least 3 to 5 days to completely close.

C. Both the arachnoid and dural layers are violated; however, the arachnoid violation contributes more significantly to cerebrospinal fluid leakage.

D. The U-shaped dural flap created by a cutting needle is likely to lead to significant cerebrospinal fluid leakage.

C is correct. The size and morphology of arachnoid lesions seem to be more important for laminar sealing and cerebrospinal leakage than the size and morphology of dural lacerations.

A is incorrect. Passing a needle into the dural sac creates a lesion in both the dura mater and arachnoid layer.

B is incorrect. The dural defect created by a cutting spinal needle is almost completely occluded after approximately 15 minutes.

D is incorrect. After needle withdrawal, the U-shaped flap created by a cutting needle returns to the original position due to CSF pressure and the elastic properties of the dura.

Which of the following statements regarding the anatomical and equipment-related factors of postdural ...

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