The Innervation of the Cranial Dura Mater: Neurosurgical Case Correlates and a Review of the Literature

OBJECTIVE: Headache and postcraniotomy pain can be disabling. In addition, generation of pain on manipulation of dural membranes during an awake craniotomy can limit the mapping procedure and create significant discomfort for the patient. There is controversy regarding the distribution of innervation of the cranial dura mater. Our aim was to review the literature regarding the innervation of the cranial dura mater and provide surgical case illustrations to highlight the relevance of such innervation to the neurosurgeon. METHODS: A review of the literature regarding the nerves thought to innervate the cranial dura mater was performed. Case illustrations are provided to highlight such innervation patterns. RESULTS: The cases provided reinforce the finding that the posterior part of the falx cerebri, tentorium cerebelli, and the dura mater along the middle cranial fossa floor are heavily innervated and most likely cause intense pain by their manipulation, which should therefore be avoided, if possible, during surgical procedures. CONCLUSIONS: Knowledge of the nerves that supply the dura mater of the skull and their pathways is important to the clinician who treats headache and to the neurosurgeon who operates in this region.