1、THE MENINGES AND BLOOD VESSELS OF BRAIN AND SPINAL CORD, AND THE CEREBROSPINAL FLUID腦和脊髓的被膜、血管及腦脊液循環(huán),Meninges of Brain and Spinal Cord,The spinal cord and brain are surrounded by three membranes, the meninges. Named from the outside inward they are Dura mater 硬膜 Arachnoid mater 蛛網(wǎng)膜 Pia mater 軟膜,The

2、Meninges of Spinal Cord,Spinal dura mater 硬脊膜 Spinal arachnoid mater脊髓蛛網(wǎng)膜 Spinal pia mater 軟脊膜,Spinal Dura Mater 硬脊膜,Characters A dense, fibrous membrane that encloses the spinal cord and cauda equina（馬尾） Above, attached to circumference of foramen magnum （枕骨大孔） Below, becomes thinner at level of S2

3、, invests filum terminale（終絲）to attach at back of coccyx On each side, continuous with external membrane of spinal nerves at intervertebral foramina（椎間孔）,Spinal Arachnoid Mater 脊髓蛛網(wǎng)膜,半透明的薄膜 ，位于硬脊膜與軟脊膜之間，與腦蛛網(wǎng)膜相延續(xù),Spinal Pia Mater 軟脊膜,緊貼脊髓表面，并延伸至脊髓的溝裂中，向上經(jīng)枕骨大孔與軟腦膜相延續(xù)，向下在脊髓圓錐下端移行為終絲。 軟脊膜在脊髓兩側(cè)脊神經(jīng)前、后根之間形

4、成齒狀韌帶,Epidural space 硬膜外隙 Position: lies between spinal dura mater 硬脊膜and periosteum of vertebral canal 椎管內(nèi)膜 Contents: a quantity of loose connective tissue, fat 脂肪, lymphatic vessels 淋巴and vertebral venous plexus 靜脈叢, the spinal nerves 脊神經(jīng)根on each side pass through the epidural space which is appli

5、cable for block anesthesia 硬膜外麻醉 Subdural space 硬膜下隙,Subarachnoid Space 蛛網(wǎng)膜下隙,Position: lies between pia and arachnoid maters containing cerebrospinal fluid 脊髓蛛網(wǎng)膜與軟脊膜之間,充滿(mǎn)腦脊液 Terminal cistern 終池: the largest part of subarachnoid space extending from termination of spinal cord to level of S2, where i

6、t is occupied by nerves of cauda equina （馬尾）, so it is the best site for a lumbar puncture 蛛網(wǎng)膜下隙的下部，自脊髓下端至第2骶椎擴(kuò)大為終池，內(nèi)有馬尾。,脊髓被膜和腔隙,C4,L2,Lumbar spinal puncture (spinal tap),The Meninges of Brain,Cerebral dural mater 硬腦膜 Cerebral arachnoid mater 腦蛛網(wǎng)膜 Cerebral pia mater 軟腦膜,Cerebral Dural Mater 硬腦膜,Cha

7、racters A thick and dense inelastic membrane that composed of two layers, an inner or meningeal and outer or endosteal 由兩層合成, 間有豐富的血管和神經(jīng) It is in loose contact with calvaria, and most strongly adherent to base of skull 硬腦膜與顱蓋骨連接疏松，易于分離，硬腦膜在顱底處與顱骨結(jié)合緊密,硬膜外血腫 腦脊液鼻漏,Cerebral dural mater 硬腦膜,Four septa C

8、erebral falx 大腦鐮 Tentorium of cerebellum 小腦幕 in front there is a gap, the tentorial incisure 幕切跡, for passage of midbrain Cerebellar falx 小腦鐮 Diaphragma sellae 鞍隔,大腦鐮,小腦幕,小腦鐮,Cerebral Dural Mater 硬腦膜,Sinuses of duramater 硬腦膜竇 Superior sagittal sinus 上矢狀竇 Inferior sagittal sinus 下矢狀竇 Straight sinus 直

9、竇 Confluence of sinus 竇匯,CEREBRAL DURAL MATER 硬腦膜,Transverse sinus 橫竇 Sigmoid sinus 乙狀竇 Superior petrosal sinuses 巖上竇 inferior petrosal sinuses 巖下竇,Cavernous sinus 海綿竇,上矢狀竇,下矢狀竇,直竇,竇匯,橫竇,乙狀竇,海綿竇,巖上竇,巖下竇,頸內(nèi)靜脈,Lateral projection from a magnetic resonance venogram磁共振造影 using time-of-flight methods.,Fro

10、ntal projection from a magnetic resonance venogram磁共振造影 using time-of-flight methods.,The flowing of the blood in dural sinus,Sup. sagittal sinus 上矢狀竇,Inf. sagittal sinus 下矢狀竇,Straight sinus 直竇,Confluence of sinus 竇匯,Transverse sinus 橫竇,Cavernous sinus 海綿竇,Sup. petrosal sinus 巖上竇,Inf. petrosal sinus

11、 巖下竇,Internal jugular vein 頸內(nèi)靜脈,Sigmoid sinus 乙狀竇,Cerebral Dural Mater 硬腦膜,Cavernous sinus 海綿竇 Position: lies on each side of sella turcica 蝶鞍 Traversing the cavernous sinus Internal carotid artery 頸內(nèi)動(dòng)脈 Abducent nerve 展神經(jīng) Traversing the lateral wall of the cavernous sinus Oculomotor nerve 動(dòng)眼神經(jīng) Troch

12、lear nerve 滑車(chē)神經(jīng) Ophthalmic nerve 眼神經(jīng)（三叉神經(jīng)第1支） Maxillary nerve 上頜神經(jīng)（三叉神經(jīng)第2支）,Cerebral Dural Mater 硬腦膜,瞳孔散大、光反射消失、眼瞼下垂、復(fù)視、眼球各方運(yùn)動(dòng)受限或固定、三叉神經(jīng)第1、2支分布區(qū)痛覺(jué)減退、角膜反射消失等,Cavernous sinus Syndrome,Cerebral Arachnoid Mater 腦蛛網(wǎng)膜,腦蛛網(wǎng)膜在大腦縱裂和大腦橫裂處伸入溝內(nèi)，此外，均跨越腦的溝裂而不伸入溝內(nèi)。 故蛛網(wǎng)膜下隙的大小不一，此隙在某些部位擴(kuò)大稱(chēng)蛛網(wǎng)膜下池（subarachnoid cisrterns

13、） 。,Subarachnoid Cisterns 蛛網(wǎng)膜下池,Cerebellomedullary cistern 小腦延髓池 Chiasmatic cistern 交叉池 Interpeduncular cistern 腳間池 Pontine cistern 腦橋池 Superior cistern 上池,Cerebellomedullary cistern,小腦延髓池,CEREBRAL ARACHNOID MATER 腦蛛網(wǎng)膜,Arachnoid granulations 蛛網(wǎng)膜粒 在上矢狀竇形成許多絨毛狀突起，突入上矢狀竇內(nèi)，腦脊液經(jīng)這些蛛網(wǎng)膜粒滲入硬腦膜竇內(nèi)，回流入靜脈,CEREBR

14、AL PIA MATER 軟腦膜,Closely invests brain surface In some areas the pia invaginates into ventricles to take part in the formation of choroids plexus 腦室的一定部位，軟腦膜及其血管與該部的室管膜上皮共同構(gòu)成脈絡(luò)組織 脈絡(luò)叢是產(chǎn)生腦脊液的主要結(jié)構(gòu),硬膜外,硬膜下,硬膜外血腫,Intracranial hemorrhages,Subdural hematoma 硬膜下血腫 blood collects between the dura and arachno

15、id,Intracranial hemorrhages,Subarachnoid hemorrhage 蜘蛛膜下腔出血 blood flows into the subarachnoid space and mixes with cerebrospinal fluid,LATERAL VENTRICLE 側(cè)腦室,Communication interventricular foramen (室間孔) third ventricle,腦脊液循環(huán),Third ventricle 第三腦室,Communication By the Interventricular foramen lateral v

16、entricle 側(cè)腦室 by mesencephalic aqueduct 中腦水管 fourth ventricle,Position: a narrow cleft lies within diencephalon.,FOURTH VENTRICLE,(1) Median aperture of fourth ventricle 第四腦室正中孔 (2) lateral apertures of fourth ventricle 第四腦室外側(cè)孔：a pair.,Subarachnoid space 蛛網(wǎng)膜下隙,Communication 交通,(3) mesencephalic aqued

17、uct （cerebral aqueduct ）中腦水管（大腦導(dǎo)水管）,Circulation of Cerebrospinal Fluid (CSF),Cerebrospinal fluid is a clear colorless fluid Nourishes brain Removes waste Conducts chemical signals between parts of CNS Liquid cushion for brain and spinal cord 對(duì)中樞神經(jīng)系統(tǒng)起緩沖、保護(hù)、運(yùn)輸代謝產(chǎn)物和調(diào)節(jié)顱內(nèi)壓等作用 Production: produced by the

18、choroids plexuses（脈絡(luò)組織） within the lateral, third and fourth ventricles,CIRCULATION OF CEREBROSPINAL FLUID (CSF),CSF drains from lateral ventricle 側(cè)腦室脈絡(luò)叢產(chǎn)生腦脊液,interventricular foramina 室間孔,third ventricle 第三腦室 脈絡(luò)叢產(chǎn)生腦脊液,mesencephalic aqueduct 中腦水管,fourth ventricle 第四腦室脈絡(luò)叢產(chǎn)生腦脊液,median and two lateral

19、apertures,subarachnoid space 蛛網(wǎng)膜下隙,arachnoid granulations,superior sagittal sinus,vein,外側(cè)孔、正中孔,蛛網(wǎng)膜粒,上矢狀竇,靜脈,HYDROCEPHALUS 腦積水,BLOOD VESSELS OF BRAIN AND SPINAL CORD腦和脊髓血管,ARTERIES OF BRAIN,Two sources Internal carotid artery 頸內(nèi)動(dòng)脈: supplies anterior 2/3 of cerebral hemisphere and parts of diencephalo

20、n 間腦 Vertebral artery 椎動(dòng)脈: supplies postterior 1/3 of cerebral hemisphere and parts of diencephalon 間腦, brain stem and cerebellum,INTERNAL CAROTID ARTERY 頸內(nèi)動(dòng)脈,Branches Anterior cerebral artery 大腦前動(dòng)脈 Middle cerebral artery 大腦中動(dòng)脈 Anterior choroidal artery 脈絡(luò)叢前動(dòng)脈 Posterior communicating artery 后交通動(dòng)脈,IN

21、TERNAL CAROTID ARTERY 頸內(nèi)動(dòng)脈,Anterior cerebral artery 大腦前動(dòng)脈 前交通支 Cortical branches 皮質(zhì)支: 供應(yīng)頂枕溝以前的半球內(nèi)側(cè)面、額葉底面的一部分和額、頂兩葉上外側(cè)面的上部 Central branches 中央支: 供應(yīng)尾狀核、豆?fàn)詈饲安亢蛢?nèi)囊前肢,INTERNAL CAROTID ARTERY 頸內(nèi)動(dòng)脈,Middle cerebral artery 大腦中動(dòng)脈 Cortical branches: 供應(yīng)大腦半球上外側(cè)面的大部分和島葉，其中包括第軀體運(yùn)動(dòng)中樞、第軀體感覺(jué)中樞和語(yǔ)言中樞 Central branches: 供

22、應(yīng)尾狀核、豆?fàn)詈?、?nèi)囊膝和后肢的前部,Projection fibers:投射纖維 connect cortex with lower part of brain and spinal cord and they include both ascending and descending fibers,White matter - cerebral medullary,內(nèi)囊,Position a thick lamina of white matter lying between caudate nucleus, thalamus and lentiform Nucleus. 位于尾狀核，背側(cè)

23、丘腦，豆?fàn)詈酥g, Internal capsule,Lentiform nucleus,Head of caudate nucleus,Dorsal thalamus,Division：,The internal capsule may be divided into 3 parts Anterior limb 前肢： Genu 膝: Posterior limb 后肢:,lie between the head of caudate nucleus and lentiform nucleus,the junction of anterior and posterior limbs,lie

24、between the thalamus and lentiform nucleus,Lentiform nucleus,Head of caudate nucleus,Dorsal thalamus,Anterior limb 前肢,Anterior thalamic radiation 丘腦前輻射 Frontopontine tract 額橋束,Genu of internal capsule 內(nèi)囊膝,Containing: corticonuclear tract 皮質(zhì)核束,Lentiform nucleus,Head of caudate nucleus,Dorsal thalamus

25、,Posterior limb of internal capsule 內(nèi)囊后肢,Corticospinal tract 皮質(zhì)脊髓束 Corticorubral tract 皮質(zhì)紅核束 Central thalamic radiations 丘腦中央輻射,Posterior limb of internal capsule 內(nèi)囊后肢,Acoustic radiation 聽(tīng)輻射,Optic radiation 視輻射,Optic radiation,Acoustic radiation,臨床意義,對(duì)側(cè)偏癱 （皮質(zhì)核束和 皮質(zhì)脊髓束損傷） 對(duì)側(cè)偏身感覺(jué)喪失 （丘腦中央輻射損傷） 對(duì)側(cè)同向偏盲 （

26、視輻射損傷）,（“三偏綜合征”）,Hemiplegic gait; The patients right side is effected,Contrast-enhanced MR image from a patient of embolic stroke,INTERNAL CAROTID ARTERY 頸內(nèi)動(dòng)脈,Anterior choroidial artery 脈絡(luò)叢前動(dòng)脈：沿視束下面向后外行，終止于脈絡(luò)叢。供應(yīng)外側(cè)膝狀體、內(nèi)囊后肢的后下部、大腦腳底的中3/5及蒼白球等結(jié)構(gòu) Posterior communicating artery 后交通動(dòng)脈: 與大腦后動(dòng)脈吻合,VERTEBRAL

27、 ARTERY 椎動(dòng)脈,VERTEBRAL ARTERY 椎動(dòng)脈,Cranial branches Anterior and posterior spinal arteries 脊髓前、后動(dòng)脈 Posterior inferior cerebellar artery 小腦下后動(dòng)脈 Branches of basilar artery Anterior inferior cerebral artery小腦下前動(dòng)脈 Labyrinthine artery 迷路動(dòng)脈 Pontine arteries 腦橋動(dòng)脈 Superior cerebellar artery 小腦上動(dòng)脈 Posterior ce

28、rebral artery 大腦后動(dòng)脈,VERTEBRAL ARTERY 椎動(dòng)脈,Posterior cerebral artery 大腦后動(dòng)脈 Cortical branches 皮質(zhì)支: supply medial and inferior surfaces of temporal lobe and occipital lobe 皮質(zhì)支分布于顳葉的內(nèi)側(cè)面和底面及枕葉 Central branches 中央支: supply dorsal thalamus, medial geniculate body, hypothalamus and subthalamus 背側(cè)丘腦、內(nèi)側(cè)膝狀體、外側(cè)膝

29、狀體、下丘腦和底丘腦,CIRCLE OF WILLIS 基底動(dòng)脈環(huán),Formation 由兩側(cè)大腦前動(dòng)脈起始段、兩側(cè)頸內(nèi)動(dòng)脈末端、兩側(cè)大腦后動(dòng)脈借前、后交通動(dòng)脈共同組成 Position 位于腦底下方，蝶鞍上方，環(huán)繞視交叉、灰結(jié)節(jié)及乳頭體周?chē)?VEINS OF BRAIN,Superficial cerebral veins Drain blood from cortex and subcortical medullary substance and empty into adjacent sinuses of dura mater 淺組收集腦皮質(zhì)及皮質(zhì)下髓質(zhì)的靜脈血，直接注入鄰近的靜脈竇,VEINS OF BRAIN,Deep cerebral veins Drain deeper parts of hemispheres, basal nuclei, internal capsule diencephalon and choroid plexus Ultimately form great cerebral vein 大腦大靜脈 which