《脑和脊髓被膜、血管及脑脊液循环》.ppt

第二十章脑和脊髓被膜 血管及脑脊液循环 第一节脑和脊髓被膜Themeningealcoveringsofthebrainandspinalcord 一 脊髓的被膜Themeningesofspinalcord spinalduramater硬脊膜spinalarachnoidmater脊髓蛛网膜spinalpiamater软脊膜 epiduralspace硬膜外隙Position liesbetweenspinalduramaterandperiosteumofvertebralcanalContents aquantityoflooseconnectivetissue fat lymphaticvesselsandvertebralvenousplexus thespinalnervesoneachsidepassthroughtheepiduralspacewhichisapplicableforblockanesthesiasubduralspace硬膜下隙 1 硬脊膜spinalduramater 2 脊髓蛛网膜spinalarachnoidmater CharactersAthin delicate tubularmembranlooselyinvestingspinalcordAbove itiscontinuouswithcerebralarachnoidmater Subarachnoidspace蛛网膜下隙Position liesbetweenpiaandarachnoidmaterscontainingcerebrospinalfluidTerminalcistern终池 thelargestpartofsubarachnoidspaceextendingfromterminationofspinalcordtolevelofS2 whereitisoccupiedbynervesofcaudaequina soitisthebestsiteforalumbarpuncture Subarachnoidspace蛛网膜下隙Position liesbetweenpiaandarachnoidmaterscontainingcerebrospinalfluidTerminalcistern终池 thelargestpartofsubarachnoidspaceextendingfromterminationofspinalcordtolevelofS2 whereitisoccupiedbynervesofcaudaequina soitisthebestsiteforalumbarpuncture 脊髓被膜 硬膜外隙和蛛网膜下隙 epiduralspace subarachnoidspace Lumbarspinalpuncture spinaltap 3 软脊膜spinalpiamater AdelicatevascularmembranethatcloselyinveststhespinalcordDenticulateligament齿状韧带 extendingfromspinalcordoneachsidebetweenanteriorandposteriorrootsofspinalnervestospinalduramate theseligamentshelptofixpositionofspinalcord Filumterminale anextensionofpiabeyondconusmedullaris 软脊膜spinalpiamaterDenticulatelig 二 脑的被膜themeningesofbrain Cerebralduralmater硬脑膜Cerebralarachnoidmater脑蛛网膜Cerebralpiamater软脑膜 Themeningealcoveringsofthebrainandspinalcord 硬膜蛛网膜软膜间隙 spinalcord spinalduramater cerebralarachnoidmater cerebralpiamater 硬膜外隙epidura extradura space硬膜下隙subduraspace蛛网膜下隙subarachnoidspace spinalarachnoidmater cerebralduramater brain spinalpiamater 1 硬脑膜cerebralduralmater CharactersAthickanddenseinelasticmembranethatcomposedoftwolayers aninnerormeningealandouterorendosteal 外层为骨内膜层endosteallayer 内层为脑膜层meningeallayer Itisinloosecontactwithcalvaria andmoststronglyadherenttobaseofskull 1 septaofcerebralduralmatercerebralfalx大脑镰tentoriumofcerebellum小脑幕 infrontthereisagap thetentorialincisure幕切迹 forpassageofmidbraincerebellarfalx小脑镰diaphragmasellae鞍隔 2 sinusesofduramater硬脑膜窦Superiorsagittalsinus上矢状窦Inferiorsagittalsinus下矢状窦Straightsinus直窦Confluenceofsinus窦汇 Transversesinus横窦Sigmoidsinus乙状窦Superiorpetrosalsinuses岩上窦inferiorpetrosalsinuses岩下窦 Cavernoussinus海绵窦Position liesoneachsideofsellaturcicaRelationsofcavernoussinus internalcarotidarteryandabducentnerverunthroughthesinusoculomotorandtrochlearnervesandophthalmicandmaxillarydivisionsoftrigeminalnervelieinthelateralwallofthesinus Superiorsagittalsinus inferiorpetrosalsinus inferiorsagittalsinus straightsinus confluenceofsinus transversesinus cavernoussinus sigmoidsinus superiorpetrosalsinus 硬脑膜窦 上矢状窦 下矢状窦 直窦 窦汇 横窦 乙状窦 颈内静脉 海绵窦 岩下窦 岩上窦 大脑镰 小脑幕 小脑幕切迹 2 脑蛛网膜cerebralarachnoidmater Characters adelicatemembranecoveringbrainloosely passingoversulciandenteringonlycerebrallongitudinalandtransversefissuresSubarachnoidspace蛛网膜下隙 Arachnoidgranulations蛛网膜粒projectintosinusesofduramater serveassiteswherecerebrospinalfluiddiffusesintobloodstream SubarachnoidcisternsInterpeduncularcistern脚间池Superiorcistern上池Pontinecistern桥池 Cerebellomedullarycistern小脑延髓池 Cerebellomedullarycistern 3 软脑膜cerebralpiamater Closelyinvestsbrainsurface insomeareasthepiainvaginatesintoventriclestotakepartintheformationofchoroidsplexus 第二节脑和脊髓的血管Thebloodvesselsofthebrainandspinalcord 一 脑的血管Thebloodvesselsofthebrain 人脑占体重的2 但约需全身供血量的20 一 脑的血管Thebloodvesselsofthebrain TwosourcesInternalcarotidartery suppliesanterior2 3ofcerebralhemisphereandpartsofdiencephalonVertebralartery suppliespostterior1 3ofcerebralhemisphereandpartsofdiencephalon brainstemandcerebellum 1 脑的动脉arteriesofbrain 1 颈内动脉internalcarotidartery Anteriorcerebralartery大脑前动脉Middlecerebralartery大脑中动脉Anteriorchoroidalartery脉络丛前动脉Posteriorcommunicatingartery后交通动脉 JoinedbytheanteriorcommunicatingarteryCorticalbranches supplymedialsurfaceofthecerebralcortexCentralbranches supplycaudatenucleus anteriorpartoflentiformnucleusandanteriorlimbofinternalcapsule anteriorcerebralartery大脑前动脉 middlecerebralartery大脑中动脉Corticalbranches supplymostofsuperolateralsurfaceofcerebralhemisphereandinsularlobeCentralbranches supplylentiformandcaudatenuclei genuandposteriorlimbofinternalcapsule lenticulostriateartery middlecerebralartery 分支 分为中央支和皮质支 供血范围 皮质支 营养大脑半球上外侧面的大部分和岛叶 包括躯体运动中枢 躯体感觉中枢和语言中枢 左侧 中央支 营养尾状核 豆状核 内囊膝和后肢的前部 临床意义 大脑中动脉远侧部阻塞 将导致皮质支营养区神经功能障碍 中央前回下2 3受损 病灶对侧上肢肌硬瘫 面神经和舌下神经核上瘫 中央后回下2 3受损 病灶对侧头面 上肢和躯体感觉障碍 左额中回后部受损 出现失写症 左额下回后部受损 出现运动性失语症 左颞上回后部受损 出现感觉性失语症 角回受损 出现失读症 临床意义 中央支阻塞或出血 将出现三偏综合征 损伤丘脑中央辐射 对侧半身躯体感觉障碍 偏麻 损伤皮质核束 对侧面神经核上瘫和舌下神经核上瘫 损伤皮质脊髓束 对侧上 下肢肌痉挛性瘫痪 损伤视辐射 双眼视野对侧同向性偏盲 internalcapsule Dorsalthalamus caudatenucleus lenticularnucleus 内囊前肢 大脑前动脉内囊膝 大脑中动脉内囊后肢前部 大脑中动脉内囊后肢后下部 脉络膜前动脉 anteriorchoroidalartery脉络丛前动脉Itsupplieslateralgeniculatebody posteriorlimbofinternalcapsule middle3 5ofcruscerebri andglobuspallidusposteriorcommunicatingartery后交通动脉 脑桥动脉 大脑后动脉 小脑上动脉 小脑下前动脉 小脑下后动脉 脊髓后动脉 脊髓前动脉 基底动脉 anteriorandposteriorspinalarteries脊髓前 后动脉posteriorinferiorcerebellarartery小脑下后动脉basilarartery基底动脉branches labyrinthineartery迷路动脉anteriorinferiorcerebralartery小脑下前动脉pontinearteries脑桥动脉superiorcerebellarartery小脑上动脉posteriorcerebralartery大脑后动脉 迷路动脉 2 椎动脉vertebralartery Corticalbranches supplymedialandinferiorsurfacesoftemporallobeandoccipitallobeCentralbranches supplydorsalthalamus medialandlateralgeniculatebodies hypothalamusandsubthalamus posteriorcerebralartery大脑后动脉 大脑后动脉起始部与小脑上动脉根部之间夹有动眼神经 当小脑幕上部颅脑病变引起颅内压增高时 位于小脑幕切迹上方的海马旁回和钩可能被挤入小脑幕切迹 使大脑后动脉向下移位 压迫或牵拉动眼神经 导致动眼神经麻痹 动眼神经 cerebralarterialcircle circleofWillis Formation formedbyanteriorcommunicatingartery bothanteriorcerebralarteries internalcarotidarteries posteriorcommunicatingarteries andposteriorcerebralarteriesPosition liesonsellaturcicaaroundopticchiasma tubercinereumandmamillarybodies 3 脑的静脉veinsofbrain 1 externalcerebralveins superficialcerebralveins Superior middle inferiorcerebralveinsemptyintoadjacentsinusesofduramater 2 internalcerebralveins deepcerebralveins formgreatcerebralveinwhichenterstraightsinus 二 脊髓的血管Thebloodvesselsofthespinalcord 1 脊髓的动脉arteriesofspinalcordTwosourcesAnteriorandposteriorspinalarteriesBranchesofsegmentalarteries radiculararteriesofposteriorintercostalsarteries lumbararteries andlateralsacralarteries Bloodvesselsofspinalcord arteriesofspinalcord 脊髓的动脉部分来自椎动脉 部分来自一些节段性动脉 如肋间后动脉 腰动脉等 脊髓前 后动脉anterior posteriorspinalartery危险区 T1 4 L1 Bloodvesselsofspinalcord 2 脊髓的静脉veinsofspinalcord drainintointernalvertebralvenousplexus 第三节脑脊液及其循环thecerebrospinalfluid CSF circulation circulationofcerebrospinalfluid CSF producedbythechoroidsplexuseswithinthelateral thirdandfourthventricles CSFdrainsfromlateralventricle interventricularforamina thirdventricle mesencephalicaqueduct fourthventricle medianandtwolateralapertures subarachnoidspace arachnoidgranulations superiorsagittalsinus vein 大脑外侧面内侧面 大脑深部髓质 基底核 间脑 脉络丛 大脑下静脉 大脑上静脉 大脑中静脉 上矢状窦 窦汇 海绵窦 横窦 乙状窦 岩上窦 岩下窦 下矢状窦 直窦 颈内静脉 大脑内静脉 大脑大静脉 侧脑室脉络丛产生脑脊液 侧脑室 室间