脑膜脑脊液脑血管

The Meninges and Blood Vessels of Brain and Spinal Cord,and the Cerebrospinal FluidThe Meninges of Brain and Spinal CordnThe spinal cord and brain are surrounded by three membranes,the meninges.Named from the outside inward they are the dura mater,arachnoid,and pia mater.The meninges of spinal cord nSpinal dura mater 硬脊膜硬脊膜nSpinal arachnoid mater脊髓蛛网膜脊髓蛛网膜 nSpinal pia mater 软脊膜软脊膜Spinal dura mater 硬脊膜硬脊膜 CharactersnAbove,attached to circumference of foramen magnumnBelow,becomes thinner at level of S2,invests filum terminale to attach at back of coccyxEpidural space 硬膜外隙硬膜外隙nPosition:lies between spinal dura mater and periosteum of vertebral canal nContents:a quantity 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 anesthesiaSubdural space硬膜下隙Spinal arachnoid mater 脊髓蛛网膜脊髓蛛网膜 CharactersnA thin,delicate,tubular membran loosely investing spinal cordnAbove,it is continuous with cerebral arachnoid materSubarachnoid space 蛛网膜下隙蛛网膜下隙nPosition:lies between pia and arachnoid maters containing cerebrospinal fluidnTerminal cistern 终池终池:the largest part of subarachnoid space extending from termination 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 Lumbar spinal puncture(spinal tap)Spinal pia mater 软脊膜软脊膜nA delicate vascular membrane that closely invests the spinal cordnDenticulate ligament齿状韧带齿状韧带:consist of 21 pairs triangular ligaments 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.nFilum terminale:an extension of pia beyond conus medullarisThe Meninges of BrainnCerebral dural mater 硬脑膜硬脑膜nCerebral arachnoid mater 脑蛛网膜脑蛛网膜nCerebral pia mater 软脑膜软脑膜Cerebral dural mater 硬脑膜硬脑膜CharactersnA thick and dense inelastic membrane that composed of two layers,an inner or meningeal and outer or endostealnIt is in loose contact with calvaria,and most strongly adherent to base of skullFour septa nCerebral falx 大脑镰大脑镰nTentorium of cerebellum小脑幕小脑幕in front there is a gap,the tentorial incisure 幕切迹幕切迹,for passage of midbrainnCerebellar falx 小脑镰小脑镰nDiaphragma sellae 鞍隔鞍隔Sinuses of duramater 硬脑膜窦硬脑膜窦nSuperior sagittal sinus 上矢状窦上矢状窦 nInferior sagittal sinus 下矢状窦下矢状窦 nStraight sinus 直窦直窦 nConfluence of sinus 窦汇窦汇 nTransverse sinus 横窦横窦 nSigmoid sinus 乙状窦乙状窦nSuperior petrosal sinuses 岩上窦岩上窦ninferior petrosal sinuses 岩下窦岩下窦Cavernous sinus 海绵窦海绵窦nPosition:lies on each side of sella turcicanRelations of cavernous sinus:qInternal carotid artery and abducent nerve run through the sinus qOculomotor and trochlear nerves and ophthalmic and maxillary divisions of trigeminal nerve lie in the lateral wall of the sinus The flowing of the blood in dural sinus Sup.sagittal sinus Inf.sagittal sinus Straight sinus Confluence of sinus Transverse sinus Cavernous sinus Sup.petrosal sinus Inf.petrosal sinus Internal jugular vein Sigmoid sinusCerebral arachnoid mater 脑蛛网膜脑蛛网膜nCharacters:a delicate membrane covering brain loosely,passing over sulci and entering only cerebral longitudinal and transverse fissures nArachnoid granulations 蛛网膜粒蛛网膜粒 project into sinuses of dura mater,serve as sites where cerebrospinal fluid diffuses into bloodstreamnSubarachnoid cisternsqCerebellomedullary cistern 小脑延髓池小脑延髓池qInterpeduncular cistern 脚间池脚间池qPontine cistern 桥池桥池qSuperior cistern 上池上池Cerebellomedullary cisternCerebral pia mater 软脑膜软脑膜nClosely invests brain surface,in some areas the pia invaginates into ventricles to take part in the formation of choroids plexus Circulation of cerebrospinal fluid(CSF)nCerebrospinal fluid is a clear colorless fluid,which acts as a transport medium for nutrients and vaster products and provides a protective fluid cushion for the central nervous system.nProduction:produced by the choroids plexuses within the lateral,third and fourth ventriclesCirculation of cerebrospinal fluidCSF drains from lateral ventricleinterventricular foraminathird ventriclemesencephalic aqueductfourth ventriclemedian and two lateral aperturessubarachnoid spacearachnoid granulationssuperior sagittal sinusveinBlood vessels of brain and spinal cordArteries of brainTwo sourcesnInternal carotid artery:supplies anterior 2/3 of cerebral hemisphere and parts of diencephalonnVertebral artery:supplies postterior 1/3 of cerebral hemisphere and parts of diencephalon,brain stem and cerebellumInternal carotid artery 颈内动脉颈内动脉nAnterior cerebral artery 大脑前动脉大脑前动脉 nMiddle cerebral artery 大脑中动脉大脑中动脉 nAnterior choroidal artery 脉络丛前动脉脉络丛前动脉nPosterior communicating artery 后交通动脉后交通动脉Anterior cerebral artery大脑前动脉大脑前动脉nJoined the fellow of the opposite side by the anterior communicating arterynCortical branches:supply all medial surface of the cerebral cortex as far back as the parietooccipital sulcus and superior border of the suprolateral surface of the cerebral hemisphere nCentral branches:supply caudate nucleus,anterior part of lentiform nucleus and anterior limb of internal capsuleMiddle cerebral artery大脑中动脉大脑中动脉nCortical branches:supply most of superolateral surface of cerebral hemisphere and insular lobe nCentral branches:supply lentiform and caudate nuclei,genu and posterior limb of internal capsule(lenticulostriate artery)nAnterior choroidal artery脉络丛脉络丛前动脉前动脉:passes backward,enters inferior horn of lateral ventricle,and ends in choroid plexus.It supplies lateral geniculate body,posterior limb of internal capsule,middle 3/5 of crus cerebri,and globus pallidusnPosterior communicating artery后交通动脉后交通动脉:runs backward to join posterior cerebral arteryVertebral artery 椎动脉椎动脉nCranial brancheqAnterior and posterior spinal arteries 脊髓前、后动脉qPosterior inferior cerebellar artery 小脑下后动脉nBranches of basilar arteryqAnterior inferior cerebral artery小脑下前动脉qLabyrinthine artery 迷路动脉qPontine arteries 脑桥动脉qSuperior cerebellar artery 小脑上动脉qPosterior cerebral artery 大脑后动脉大脑后动脉 Posterior cerebral arterynCortical branches:supply medial and inferior surfaces of temporal lobe and occipital lobenCentral branches:supply dorsal thalamus,medial and lateral geniculate bodies,hypothalamus and subthalamusCerebral arterial circle(circle of Willis)nFormation:formed by anterior communicating artery,both anterior cerebral arteries,internal carotid arteries,posterior communicating arteries,and posterior cerebral arteriesnPosition:lies on sella turcica around optic chiasma,tuber cinereum and mamillary bodies Blockage Area of oxygendeprives brainThrombus Plaque Subarachnoid hemorrhageMicroaneurysm Lenticulostriate arteriesIntracerebral hemorhage Arteriovenous malformationVeins of brainSuperficial cerebral veins nDrain blood from cortex and subcortical medullary substance and empty into adjacent sinuses of dura mater Veins of brainnDeep cerebral veins:drain deeper parts of hemispheres,basal nuclei,internal capsule,diencephalon and choroid plexus,ultimately form great cerebral vein which enter straight sinusBlood vessels of spinal cordArteries of spinal cordnTwo sources qAnterior and posterior spinal arteriesqBranches of segmental arteries:radicular arteries of posterior intercostals arteries,lumbar arteries,and lateral sacral arteriesnDamage area:T1T4,ventral part of L1nvascular ring(vasocorona)Blood vessels of spinal cordSpinal veins:drain into internal vertebral venous plexus