Anatomical and developmental insights into the dura mater: Implications for neurosurgery and endovascular therapy

The dura mater has historically been regarded as a rigid meningeal barrier; however, accumulating evidence indicates that it is a biologically active structure with important developmental and clinical significance.

This review synthesizes the literature on the dura mater, including its historical terminology, basic architecture, embryologic development, dural septae, vascularization, and innervation.

Structurally, the dura mater consists of the endosteal, meningeal, and dural border cell (DBC) layers, whose distinct properties underlie both normal physiology and pathological processes. In particular, the fragility of the DBC layer helps explain the pathogenesis of chronic subdural hematoma, in which repeated bleeding and inflammation generate fibrous membranes within this potential cleavage plane. Embryologic studies demonstrate that dural reflections, including the falx cerebri, tentorium cerebelli, and diaphragma sellae, arise from the primitive meninx in close relation to brain morphogenesis and venous sinus development. The dural vascular network also serves as a scaffold for angiogenesis in ischemic states and plays a central role in the development of dural arteriovenous shunts.

Recognizing the dura mater as a dynamic participant in cranial development, vascular biology, and disease mechanisms refines our anatomical understanding and has important implications for neurosurgical and neuroendovascular practice.