The spinal dura mater attaches superiorly to the foramen magnum margins and the posterior body of C2, providing the cranial anchoring of the spinal dural tube. This attachment transmits tension from the cranial dura to the spinal dural sac.
Anchors the spinal dura to the skull base, transmits intracranial pressure changes to the spinal canal, and provides the superior reference for the epidural space beginning at the foramen magnum.
Dural tears at the craniovertebral junction during posterior fossa or C1-C2 surgery risk cerebrospinal fluid fistula from the high-flow intracranial compartment, requiring watertight primary repair. Spinal dural sac tension from tethered cord syndrome may alter this superior attachment.
Dural breach at the skull base attachment during posterior fossa or C1-C2 surgery producing high-volume CSF fistula requiring primary watertight repair with dural substitute graft.
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