《脑和脊髓被膜、血管及脑脊液循环》

1、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 The meningeal coverings of the brain and spinal cord,一、脊髓的被膜The meninges of spinal cord,spinal dura mater 硬脊膜 spinal arachnoid mater 脊髓蛛网膜 spinal pia mater 软脊膜,epidural space 硬膜外隙 Position: lies between spinal dura mater and periosteum of vertebral canal Contents: a q

2、uantity of loose connective tissue, fat, lymphatic vessels and vertebral venous plexus, the spinal nerves on each side pass through the epidural space which is applicable for block anesthesia subdural space 硬膜下隙,1.硬脊膜 spinal dura mater,2.脊髓蛛网膜 spinal arachnoid mater,Characters A thin, delicate, tubu

3、lar membran loosely investing spinal cord Above, it is continuous with cerebral arachnoid mater,Subarachnoid space 蛛网膜下隙 Position: lies between pia and arachnoid maters containing cerebrospinal fluid Terminal cistern 终池: the largest part of subarachnoid space extending from termination of spinal cor

4、d to level of S2, where it is occupied by nerves of cauda equina, so it is the best site for a lumbar puncture,Subarachnoid space 蛛网膜下隙 Position: lies between pia and arachnoid maters containing cerebrospinal fluid Terminal cistern 终池: the largest part of subarachnoid space extending from terminatio

5、n of spinal cord to level of S2, where it is occupied by nerves of cauda equina, so it is the best site for a lumbar puncture,脊髓被膜、硬膜外隙和蛛网膜下隙,epidural space,subarachnoid space,Lumbar spinal puncture (spinal tap),3.软脊膜 spinal pia mater,A delicate vascular membrane that closely invests the spinal cord

6、 Denticulate ligament 齿状韧带: extending from spinal cord on each side between anterior and posterior roots of spinal nerves to spinal dura mate; these ligaments help to fix position of spinal cord. Filum terminale: an extension of pia beyond conus medullaris,软脊膜 spinal pia mater Denticulate lig.,二、 脑的

7、被膜 the meninges of brain,Cerebral dural mater 硬脑膜 Cerebral arachnoid mater 脑蛛网膜 Cerebral pia mater 软脑膜,The meningeal coverings of the brain and spinal cord,硬膜 蛛网膜 软膜 间隙,spinal cord,spinal dura mater,cerebral arachnoid mater,cerebral pia mater,硬膜外隙 epidura (extradura) space 硬膜下隙 subdura space 蛛网膜下隙 s

8、ubarachnoid space,spinal arachnoid mater,cerebral dura mater,brain,spinal pia mater,1.硬脑膜 cerebral dural mater,Characters A thick and dense inelastic membrane that composed of two layers, an inner or meningeal and outer or endosteal. 外层为骨内膜层 endosteal layer，内层为脑膜层 meningeal layer. It is in loose con

9、tact with calvaria, and most strongly adherent to base of skull,1) septa of cerebral dural mater cerebral falx 大脑镰 tentorium of cerebellum 小脑幕in front there is a gap, the tentorial incisure 幕切迹, for passage of midbrain cerebellar falx 小脑镰 diaphragma sellae 鞍隔,2) sinuses of dura mater 硬脑膜窦 Superior s

10、agittal sinus 上矢状窦 Inferior sagittal sinus 下矢状窦 Straight sinus 直窦 Confluence of sinus 窦汇,Transverse sinus 横窦 Sigmoid sinus 乙状窦 Superior petrosal sinuses 岩上窦 inferior petrosal sinuses 岩下窦,Cavernous sinus 海绵窦 Position: lies on each side of sella turcica Relations of cavernous sinus: internal carotid a

11、rtery and abducent nerve run through the sinus oculomotor and trochlear nerves and ophthalmic and maxillary divisions of trigeminal nerve lie in the lateral wall of the sinus,Superior sagittal sinus,inferior petrosal sinus,inferior sagittal sinus,straight sinus,confluence of sinus,transverse sinus,c

12、avernous sinus,sigmoid sinus,superior petrosal sinus,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 cerebral arachnoid mater,Characters: a delicate membrane covering brain loosely, passing over sulci and entering only cerebral longitudinal and transverse fissures Subarachnoid spac

13、e 蛛网膜下隙,Arachnoid granulations 蛛网膜粒 project into sinuses of dura mater, serve as sites where cerebrospinal fluid diffuses into bloodstream,Subarachnoid cisterns Interpeduncular cistern 脚间池 Superior cistern 上池Pontine cistern 桥池,Cerebellomedullary cistern 小脑延髓池,Cerebellomedullary cistern,3.软脑膜 cerebra

14、l pia mater,Closely invests brain surface, in some areas the pia invaginates into ventricles to take part in the formation of choroids plexus,第二节 脑和脊髓的血管 The blood vessels of the brain and spinal cord,一、 脑的血管 The blood vessels of the brain,人脑占体重的2%，但约需全身供血量的20%。,一、 脑的血管 The blood vessels of the brai

15、n,Two sources Internal carotid artery: supplies anterior 2/3 of cerebral hemisphere and parts of diencephalon Vertebral artery: supplies postterior 1/3 of cerebral hemisphere and parts of diencephalon, brain stem and cerebellum,1.脑的动脉 arteries of brain,1) 颈内动脉 internal carotid artery,Anterior cerebr

16、al artery 大脑前动脉 Middle cerebral artery 大脑中动脉 Anterior choroidal artery 脉络丛前动脉 Posterior communicating artery 后交通动脉,Joined by the anterior communicating artery Cortical branches: supply medial surface of the cerebral cortex Central branches: supply caudate nucleus, anterior part of lentiform nucleus

17、and anterior limb of internal capsule,anterior cerebral artery 大脑前动脉,middle cerebral artery 大脑中动脉 Cortical branches: supply most of superolateral surface of cerebral hemisphere and insular lobe Central branches: supply lentiform and caudate nuclei, genu and posterior limb of internal capsule (lentic

18、ulostriate artery),middle cerebral artery,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：,

19、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。,internal capsule,Dorsal thalamus,caudate nucleus,lenticular nucleus,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,anterior choroidal artery 脉络丛前动脉 It supplies lateral geniculate body, poster

20、ior limb of internal capsule, middle 3/5 of crus cerebri,and globus pallidus posterior communicating artery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,anterior and posterior spinal arteries 脊髓前、后动脉 posterior inferior cerebellar artery 小脑下后动脉 basilar artery 基底动脉 branches ： labyrinthine art

21、ery 迷路动脉 anterior inferior cerebral artery 小脑下前动脉 pontine arteries 脑桥动脉 superior cerebellar artery 小脑上动脉 posterior cerebral artery 大脑后动脉,迷路动脉,2.椎动脉 vertebral artery,Cortical branches: supply medial and inferior surfaces of temporal lobe and occipital lobe Central branches: supply dorsal thalamus, me

22、dial and lateral geniculate bodies, hypothalamus and subthalamus,posterior cerebral artery 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,cerebral arterial circle ( circle of Willis ),Formation: formed by anterior communicating art

23、ery, both anterior cerebral arteries, internal carotid arteries, posterior communicating arteries, and posterior cerebral arteries Position: lies on sella turcica around optic chiasma, tuber cinereum and mamillary bodies,3. 脑的静脉 veins of brain,1) external cerebral veins (superficial cerebral veins)

24、Superior, middle, inferior cerebral veins empty into adjacent sinuses of dura mater,2) internal cerebral veins (deep cerebral veins) form great cerebral vein which enter straight sinus,二、脊髓的血管 The blood vessels of the spinal cord,1. 脊髓的动脉 arteries of spinal cord Two sources Anterior and posterior sp

25、inal arteries Branches of segmental arteries: radicular arteries of posterior intercostals arteries, lumbar arteries, and lateral sacral arteries,Blood vessels of spinal cord,arteries of spinal cord,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 、 posterior spinal artery 危险区(T1-4，L1),Blood v

26、essels of spinal cord,2. 脊髓的静脉 veins of spinal cord : drain into internal vertebral venous plexus,第三节 脑脊液及其循环 the cerebrospinal fluid (CSF) circulation,circulation of cerebrospinal fluid (CSF),produced by the choroids plexuses within the lateral, third and fourth ventricles,CSF drains from lateral ventricle,interventricular foramina,third ventricle,mesencephalic aqueduct,fourth ventricle,median and two lateral apertures,subarachnoid space,arachnoid granulations,superior sagittal sinus,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