后颅窝静脉脊髓血管课件_1

VENOUS DRAINAGE OF VENOUS DRAINAGE OF THE POSTERIOR FOSSATHE POSTERIOR FOSSA 长沙泰和医院神经外科长沙泰和医院神经外科 何承彪何承彪 n n The venous drainage of the posterior fossa The venous drainage of the posterior fossa can be divided into 3 groups according to the can be divided into 3 groups according to the location and direction of drainage: location and direction of drainage: 1.superior group (Galen1.superior group (Galen s s vein group) vein group) 2.anterior group (petrosal 2.anterior group (petrosal group) group) 3.posterior goup (tentorial 3.posterior goup (tentorial group) group) VENOUS DRAINAGE OF THE VENOUS DRAINAGE OF THE POSTERIOR FOSSAPOSTERIOR FOSSA 1.SUPERIOR GROUP1.SUPERIOR GROUP n n It consists of veins that drain to the vein of It consists of veins that drain to the vein of Galen, including:Galen, including: 1.The precentral cerebellar vein1.The precentral cerebellar vein 2.The superior vermian vein 2.The superior vermian vein 3.The anterior pontomesencephalic 3.The anterior pontomesencephalic vein vein 4.The lateral and posterior 4.The lateral and posterior mesencephalic veins. mesencephalic veins. 1.1 Precentral cerebellar vein1.1 Precentral cerebellar vein n n It is one of the most important landmark It is one of the most important landmark in the posterior fossa, which divides the in the posterior fossa, which divides the superior part of the posterior fossa into superior part of the posterior fossa into the anterior and posterior half. the anterior and posterior half. n n The precentral cerebellar vein lies in the The precentral cerebellar vein lies in the fissure between the lingula and central fissure between the lingula and central lobe of the cerebellar vermis. It is formed lobe of the cerebellar vermis. It is formed by the convergence of the brachial veins.by the convergence of the brachial veins. 1.3 Posterior mesencephalic vein1.3 Posterior mesencephalic vein n n It may be single or multiple, after arising from It may be single or multiple, after arising from the interpeduncular fossa, it goes along the the interpeduncular fossa, it goes along the lateral aspect of the mesencephalon, then lateral aspect of the mesencephalon, then goes posteriorly, superiorly and medially goes posteriorly, superiorly and medially around the midbrain to enter the vein of Galen around the midbrain to enter the vein of Galen or the posterior part of the internal cerebral or the posterior part of the internal cerebral vein. vein. n n Its size varies inversely with the basal vein of Its size varies inversely with the basal vein of Rosenthal. It may connect with the petrosal Rosenthal. It may connect with the petrosal vein via the lateral mesencephalic vein.vein via the lateral mesencephalic vein. 1.4 Anterior pontomesencephalic 1.4 Anterior pontomesencephalic veinvein n n It collects several small veins and runs posteriorly It collects several small veins and runs posteriorly to enter the interpeduncular fossa, then descends to enter the interpeduncular fossa, then descends along the anterior surface of the pons in the along the anterior surface of the pons in the midline. midline. n n It usually drains into the basal vein of Rosenthal It usually drains into the basal vein of Rosenthal or the posterior mesencephalic vein. In lateral or the posterior mesencephalic vein. In lateral projections, it outlines the interpeduncular cistern projections, it outlines the interpeduncular cistern and the superior pontine cistern.and the superior pontine cistern. 1.5 Lateral mesencephalic vein1.5 Lateral mesencephalic vein n n It is relatively constant and runs in the It is relatively constant and runs in the lateral aspect of the mesencephalon lateral aspect of the mesencephalon between the cerebral peduncle and the between the cerebral peduncle and the tegmentum. tegmentum. n n It drains to the basal vein of Rosenthal It drains to the basal vein of Rosenthal or posterior mesencephalic vein, and or posterior mesencephalic vein, and may also communicate with the petrosal may also communicate with the petrosal vein.vein. 1.6 Quadrigeminal vein1.6 Quadrigeminal vein n n It drains the blood from the quadrigeminal It drains the blood from the quadrigeminal bodies into the vein of Galen.bodies into the vein of Galen. 2. ANTERIOR GROUP2. ANTERIOR GROUP n n It drains the blood from the anterior surface of It drains the blood from the anterior surface of the pons, the superior and inferior part of the the pons, the superior and inferior part of the cerebellum, cerebellomedullary fissure and the cerebellum, cerebellomedullary fissure and the lateral recesses of the fourth ventricle to the lateral recesses of the fourth ventricle to the petrosal vein. petrosal vein. n n It is located in the cerebellopontine angle and It is located in the cerebellopontine angle and can be displaced by surrounding space can be displaced by surrounding space occupying lesions, which is seen in A-P occupying lesions, which is seen in A-P projection. It is a significant landmark in A-P projection. It is a significant landmark in A-P view.view. 3. POSTERIOR GROUP3. POSTERIOR GROUP n n It drains the blood from the inferior cerebellar It drains the blood from the inferior cerebellar vermins and the medial aspect of the vermins and the medial aspect of the cerebellar hemisphere to the straight sinus, cerebellar hemisphere to the straight sinus, transverse sinuses and the torcular Herophili. transverse sinuses and the torcular Herophili. n n The inferior vermian vein is the most important The inferior vermian vein is the most important vein within this group which drains blood from vein within this group which drains blood from the inferior vermis to the straight sinus or the the inferior vermis to the straight sinus or the proximal end of the transverse sinus. In lateral proximal end of the transverse sinus. In lateral view, it is at about 1cm from the inner table of view, it is at about 1cm from the inner table of the occipital bone. the occipital bone. POSTERIOR GROUPPOSTERIOR GROUP n n The posterior group includes the superior The posterior group includes the superior and inferior hemispheric vein, which drain and inferior hemispheric vein, which drain the blood from the superior and inferior the blood from the superior and inferior medial surface of the cerebellar medial surface of the cerebellar hemispheres separately into the straight hemispheres separately into the straight and transverse sinuses.and transverse sinuses. THE ARTERIAL AND THE ARTERIAL AND VENOUS ANATOMY OF VENOUS ANATOMY OF THE SPINAL CORDTHE SPINAL CORD Anterior spinal arteryAnterior spinal artery n n It arises from the It arises from the terminal end of the terminal end of the vertebral artery, and vertebral artery, and runs for about 2cm runs for about 2cm antero-inferiorly and antero-inferiorly and medially to join with the medially to join with the contralateral anterior contralateral anterior spinal artery, then it spinal artery, then it descends along the descends along the ventromedian fissure. ventromedian fissure. Posterior spinal arteryPosterior spinal artery n n About 73% of the posterior About 73% of the posterior spinal arteries arise from spinal arteries arise from the posterior inferior the posterior inferior cerebellar artery, a minority cerebellar artery, a minority of them arises from the of them arises from the vertebral artery at the level vertebral artery at the level of the medulla.of the medulla. n n It descends on the lateral It descends on the lateral side of the posteror aspect side of the posteror aspect of the medulla and the of the medulla and the spinal cord. spinal cord. The artery is rarely seen in The artery is rarely seen in vertebral artery vertebral artery angiograms.angiograms. Along its course, the branches Along its course, the branches from the vertebral artery, from the vertebral artery, ascending cervical artery, ascending cervical artery, intercostal arteries, lumbar intercostal arteries, lumbar arteries, middle sacral artery and arteries, middle sacral artery and the internal iliac artery join in the internal iliac artery join in different segments to form the different segments to form the anterior or posterior longitudinal anterior or posterior longitudinal spinal axis.spinal axis. SPINAL ARTERIESSPINAL ARTERIES Spinal arteries are divided into 3 main groups:Spinal arteries are divided into 3 main groups: n n The first goupThe first goup: It consists of the vertebral : It consists of the vertebral artery, ascending cervical artery, deep cervical artery, ascending cervical artery, deep cervical artery and the first intercostal artery ,which all artery and the first intercostal artery ,which all arise from the subclavian artery. arise from the subclavian artery. n n The second groupThe second group: It is from the intercostal : It is from the intercostal and lumbar arteries of aorta and lumbar arteries of aorta n n The third groupThe third group: from the iliolumbar artery, : from the iliolumbar artery, middle sacral artery and lateral sacral artery middle sacral artery and lateral sacral artery of the internal iliac artery.of the internal iliac artery. 1. The first group1. The first group n n It consists of the vertebral artery, ascending It consists of the vertebral artery, ascending cervical artery, deep cervical artery and the first cervical artery, deep cervical artery and the first intercostal artery which all arise from the intercostal artery which all arise from the subclavian artery. subclavian artery. n n The main branches from the subclavian artery The main branches from the subclavian artery from medial to lateral are: vertebral artery, from medial to lateral are: vertebral artery, internal thoracic artery, thyrocervical trunk, internal thoracic artery, thyrocervical trunk, costocervical trunk, all except the internal costocervical trunk, all except the internal thoracic artery supply the spinal cord and thoracic artery supply the spinal cord and vertebrae.vertebrae. 1.1 The thyro-cervical trunk1.1 The thyro-cervical trunk nIt is a short segment, which divides into several branches immediately after arising from the medial margin of the anterior scalenus, which include: n1). Inferior thyroid artery: It runs supero-medially to supply the inferior pole of the lateral lobe of the thyroid and the superior part of the oesophagus and pharynx. n2). Suprascapular artery: It supplies the supraspinatus and the infraspinatus and the scapula. n3). Ascending cervical artery: It may arise together with the inferior thyroid artery, it runs superiorly to supply the cervical muscles and mostly involves in the blood supply of the spinal cord and dura. 1.2 Costocervical trunk1.2 Costocervical trunk n n It is also short and has important branches It is also short and has important branches including the deep cervical artery and the including the deep cervical artery and the first intercostal artery, both of which supply first intercostal artery, both of which supply the cervical spinal cord.the cervical spinal cord. n n The vertebral artery, thyro-cervical trunk The vertebral artery, thyro-cervical trunk and the costocervical trunk should not be and the costocervical trunk should not be neglected in spinal angiography.neglected in spinal angiography. 2. The second group2. The second group It is from the intercostal and lumbar It is from the intercostal and lumbar arteries of aorta. arteries of aorta. Intercostal ArteryIntercostal Artery n n The aorta usually gives 7-11 pairs of intercostal arteries, The aorta usually gives 7-11 pairs of intercostal arteries, the left side ones usually arise from the midline of the the left side ones usually arise from the midline of the posterior wall, while the right ones usually from the posterior wall, while the right ones usually from the posterolateral wall. posterolateral wall. n n The origins of T2-4 intercostal arteries are at the same The origins of T2-4 intercostal arteries are at the same level of T5 vertebral body, while origins of the T5-11 level of T5 vertebral body, while origins of the T5-11 intercostal arteries are at 1 vertebral level below the intercostal arteries are at 1 vertebral level below the corresponding artery respectively. corresponding artery respectively. n n The subcostal artery is usually at the level between T12 The subcostal artery is usually at the level between T12 and L1 vertebral bodies.and L1 vertebral bodies. n n The distance between the origins of the intercostal The distance between the origins of the intercostal arteries is about 13.5-22.5mm and increases down the arteries is about 13.5-22.5mm and increases down the vertebral column.vertebral column. Lumbar ArteriyLumbar Arteriy n n There are ususlly 4 pairs of lumbar arteries. There are ususlly 4 pairs of lumbar arteries. The left ones arise from the midline of the The left ones arise from the midline of the posterior wall of the aorta, while the right posterior wall of the aorta, while the right ones usually from the posterolateral wall. ones usually from the posterolateral wall. n n There is about the distance of one vertebral There is about the distance of one vertebral body between two adjacent lumbar artery.body between two adjacent lumbar artery. 3. The third group3. The third group n n The third group:The third group: from the iliolumbar from the iliolumbar artery, middle sacral artery and lateral artery, middle sacral artery and lateral sacral artery of the internal iliac artery.sacral artery of the internal iliac artery. 4. Radicualar Artery4. Radicualar Artery n n In embryonic stage, the above arterial In embryonic stage, the above arterial groups give 31 pairs of radicular artery to groups give 31 pairs of radicular artery to enter the spinal canal through the enter the spinal canal through the intervertebral foramina along the nerve intervertebral foramina along the nerve roots. They are divided into the anterior roots. They are divided into the anterior and posterior radicualar artery (Lazorthes and posterior radicualar artery (Lazorthes artery).artery). Radicualar ArteryRadicualar Artery Radicualar arteries distribute to 3 areas: Radicualar arteries distribute to 3 areas: 1. To supply the nerve roots and the 1. To supply the nerve roots and the spinal dura spinal dura 2. To supply the pial and the peripheral 2. To supply the pial and the peripheral zone of the spinal cord zone of the spinal cord 3. To supply the intramedullary part of the 3. To supply the intramedullary part of the spinal cord. spinal cord. n n The radicular artery involving in contribution to The radicular artery involving in contribution to the third area is called the radiculomedullary the third area is called the radiculomedullary artery, in adults, most of them regress, and left artery, in adults, most of them regress, and left behind 6-8 anterior radiculomedullary arteries behind 6-8 anterior radiculomedullary arteries and 10-23 posterior radiculomedullary arteries. and 10-23 posterior radiculomedullary arteries. n n Because the origin of spinal arteries is variable, Because the origin of spinal arteries is variable, spinal arteriography shoud include all of the spinal arteriography shoud include all of the three groups mentioned above. three groups mentioned above. 4.1 Radiculomedullary Artery4.1 Radiculomedullary Artery Radiculomedullary arteriesRadiculomedullary arteries They are divided into anterior and posterior radiculomedullary arteries, the anterior one are larger in size but smaller in number. The largest anterior radiculomedullary artery is the Adamkiewicz artery. n n The radiculomedullary artery runs anterior to the The radiculomedullary artery runs anterior to the dural sheath into the intervertebral foramen . dural sheath into the intervertebral foramen . n n It penetrates the dura, and ascends anterior to the It penetrates the dura, and ascends anterior to the dentate ligament, then turns acutely downwards, at dentate ligament, then turns acutely downwards, at the same time it gives an ascending branch, in a the same time it gives an ascending branch, in a hairping manner. hairping manner. n n The anterior branch runs on the ventral median The anterior branch runs on the ventral median fissure while the posterior ones along both sides of fissure while the posterior ones along both sides of the posteriolateral sulcus medial to the posterior the posteriolateral sulcus medial to the posterior nerve roots. nerve roots. n n The ascending and descending branches are called The ascending and descending branches are called the spinal arteries.the spinal arteries. 5.5. Spinal ArteriesSpinal Arteries Spinal ArteriesSpinal Arteries 5.1 Anterior spinal arteries5.1 Anterior spinal arteries n n The first anterior spinal artery is formed by the The first anterior spinal artery is formed by the branches from bilateral vertebral arteries before branches from bilateral vertebral arteries before their anastomosis to become the basilar artery. their anastomosis to become the basilar artery. n n It starts as a single trunk from C2-3 level and It starts as a single trunk from C2-3 level and descends along the ventral median fissure , to descends along the ventral median fissure , to anastomose with ascending branches of anastomose with ascending branches of segmental spinal arteries from radiculomedullary segmental spinal arteries from radiculomedullary arteries, longitudinally along the whole length of arteries, longitudinally along the whole length of the spinal cord to the conus medullaris to form the spinal cord to the conus medullaris to form the anterior longitudinal spinal axis.the anterior longitudinal spinal axis. n n