脑血管解剖定位 ppt课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,.,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,.,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,.,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,.,*,脑血管的解剖定位,1,.,脑血管的解剖定位1.,脑的血管,The blood vessel of the brain,动 脉,Artery,静 脉,Vein,2,.,脑的血管The blood vessel of the br,脑的动脉概述,位于颅腔内，弯曲多，无搏动,血供丰富，依赖性强，缺血,5,分钟,不可逆损伤,颈内动脉系和椎基底动脉系两个系统,分支,:,皮质支和中央支,3,.,脑的动脉概述位于颅腔内，弯曲多，无搏动3.,脑动脉,的两个系统,颈内动脉系,端脑前,2/3,间脑的前部,椎基底动脉系,端脑后,1/3,间脑后部,脑干、小脑,4,.,脑动脉的两个系统4.,颈内动脉系统,5,.,颈内动脉系统5.,第四颈椎水平，体表相当于甲状软骨上缘处，,6,.,第四颈椎水平，体表相当于甲状软骨上缘处，6.,颈内动脉分段,1,2,3,4,4,前床突上段,3,海 绵 窦 段,2,岩 段,1,颈 段,7,.,颈内动脉分段12344 前床突上段3 海 绵 窦 段2 岩,1,颈段,2,岩段,3,海绵窦段,4,前床突上段,脑动脉造影颈内动脉分段,1,2,3,4,虹吸部，动脉粥样硬化好发部位,8,.,1 颈段脑动脉造影颈内动脉分段1234虹吸部，动脉粥样硬化,颈内动脉分支,入,颈内动脉,-,颅底,-,颅腔,-,经颈动脉管 通过海绵窦,-,分出 眼动脉、大脑前动脉、 大脑中动脉、后交通动脉 脉络膜动脉,9,.,颈内动脉分支 入颈内动脉-颅底-,主要供应眼部和大脑半球前,2/3,的血液（即额叶、顶叶、颞叶的一部分及基底节的血液。）,颈内动脉的供血部位,10,.,主要供应眼部和大脑半球前2/3的血液（即额叶、顶叶、,大脑中动脉从颈内动脉发出后,，,中央支,由中动脉起始处发出，经前穿质上行分为,内侧豆纹动脉,和,外侧豆纹动脉。,供血部位：,尾状核体、豆状核、内囊后肢的前,3/5,。,大脑中,A.,中央支,尾状核、豆状核、内囊膝、后肢前上部,1,、大脑中动脉（,MCA,）供血范围,11,.,大脑中动脉从颈内动脉发出后，中央支由中动脉起始处,皮层支：,进入大脑外侧裂后分布于大脑半球的外侧面。,供血部位：,额下回、额中回、颞上回、颞中回、中央前后回的下,4/5,及顶叶的缘上回与角回。,（,1,）眶额动脉（,2,）中央沟前动脉（,3,）中央沟动脉 （,4,）中央沟后动脉（,5,）顶后动脉（,6,）角回动脉（,7,）颞后动脉（,8,）颞中动脉（,9,）颞前动脉（,10,）颞级动脉,眶额动脉,眶部、额下回后部额中回前部,中央沟前动脉,额中回、额下回后部、中央前回下,4/5,中央沟动脉,中央前回下,4/5,及中央沟后缘下,4/5,中央沟后动脉,中央后回下,4/5,及顶间沟前部上下缘,顶后动脉,缘上回及顶上小叶下缘,角回动脉,角回及顶上小叶后部上缘,颞后动脉,顶后、角回、颞后动脉均供应皮质内面的膝距束，故三支动脉梗塞后均可发生同侧皮质盲。,颞中动脉,颞前动脉,颞级动脉,12,.,皮层支：进入大脑外侧裂后分布于大脑半球的外侧面。,2,、大脑前动脉（,ACA,）血液供应,13,.,2、大脑前动脉（ACA）血液供应13.,从颈内动脉发出,-,向前向上绕过胼胝体的膝部,在大脑半球内侧面,-,向后行进,-,止于顶枕裂附近,沿着胼胝体干形成弓状,。,大脑前动脉分为,中央支,和,皮层支。,1,）中央支,：,中央支进入前穿质与大脑中动脉的中央支吻合。 供血部位：,尾状前核部、壳核前,2/3,部，苍白球外侧核和内囊前肢,14,.,从颈内动脉发出-向前向上绕过胼胝体的膝部,2,）皮层支,供血部位：额叶内侧面、额级、额上回、旁中央小叶、中央前回的上,1/5,、胼胝体膝与体部的前,4/5,及脑底面和眶部的内侧面（,1,）眶动脉（,2,）额级动脉（,3,）额前动脉（,4,）额中动脉（,5,）额后动脉（,6,）旁中央动脉（,7,）楔前动脉（,8,）胼胝体动脉,供应额叶眶面、内侧面、额级,眶动脉,额级动脉,供应额级内外侧面,额前、中、,后、动脉,从胼胝体上部发出，,越过半球内侧面到,半球外侧面,旁中央动脉,旁中央小叶和中央前后回的上,1/5,楔前动脉,扣带回上部、楔前叶前,2/3,、顶上小叶和顶下小叶上缘,15,.,2）皮层支 供血部位：额叶内侧面、额级、额上回、旁中央,多数起于颈内动脉,-,沿视束向后,-,至外侧膝状体经大脑脚,-,侧脑室下角止于脉络丛,供血部位：起分支供应外侧膝状体的外侧半、视束的中部分、内囊后肢的后,2/3,、大脑脚底的中,1/3,、苍白球的大部分、侧脑室下角的脉络丛及丘脑。此动脉细小、行程长，易发生栓塞而导致苍白球和海马病变。,3,、脉络膜前动脉（,ACHA,）的供血范围,左图详示：基底节区的血液供应。,内侧豆纹动脉,外侧豆纹动脉,脉络膜前动脉,大脑后动脉穿通支,16,.,多数起于颈内动脉-沿视束向后-至外侧膝状体经,起于颈内动脉后壁,-,在视束起始端的下方穿过,-,与大脑后动脉的前壁相连（为颈内动脉和椎,基底动脉的吻合支） 。,供血部位：视交叉、视束、垂体、灰结节、丘脑下部、丘脑底部、丘脑外侧下核的较前部分、内囊后肢前的下部、大脑脚和脚间的一部分。,4,、后交通动脉（,PCOA,）的供血范围,17,.,起于颈内动脉后壁-在视束起始端的下方穿过-,5,、眼动脉的供血范围,虹吸弯,颈内动脉,-,与视神经伴行,-,发出,经视神经孔,-,入眶分出视网膜中央动脉等,供血部位：主要供应视网膜的血液。,18,.,5、眼动脉的供血范围 虹吸弯颈内动脉-,椎,基底动脉系统,19,.,椎基底动脉系统19.,1,、椎动脉,上行,起自锁骨下动脉,-,到第,5-6,颈椎横突,从环椎横突孔穿出,-,穿过第,5-6,颈椎横突孔,-,经枕骨大孔,绕行环椎侧块,-,入颅，至脑桥下缘汇成基底动脉。,基底动脉,basilar a.,椎动脉,vertebral a.,20,.,1、椎动脉 上行 起自锁骨下动脉-,脑桥支,小脑下前动脉,小脑上动脉,大脑后动脉,迷路动脉,椎基底动脉的主要分支,21,.,脑桥支小脑下前动脉小脑上动脉大脑后动脉迷路动脉椎基底动脉的主,2,、基底动脉,基底动脉沿脑桥基底动脉沟前行， 至脑桥上缘分出左右大脑后动脉。 基底动脉分支：,（,1,）脑桥动脉：,约,10,余条，均从基底动脉干上发出。包括 旁中央动脉 短旋动脉 长旋动脉 脑桥动脉主要供应桥脑底部、桥脑背盖腹侧的血液。,脑桥动脉,22,.,2、基底动脉 基底动脉沿脑桥基底动脉沟前行， 至脑桥上缘,（,2,）小脑下前动脉：,起自基底动脉的下,1/3,处，供应小脑 前下面及小脑白质与齿状核等处血液。 分支：,桥延支 内听动脉,（,3,）小脑上动脉：,起自基底动脉上段， 自动眼神经根下方行向背外侧。 供应小脑上部血液。,基底,A.,小脑下,前,A.,小脑上,A.,迷路,A.,23,.,（2）小脑下前动脉：起自基底动脉的下1/3处，供应小脑,（,4,）大脑后动脉：,为基底动脉的,终支，,跨越动眼神经的上方，绕过大脑脚向后行跨至小脑幕上，经胼胝体压部下方进入距状沟，分为距状沟动脉和顶枕动脉。 主要供应颞叶下面（颞级除外）及颞下回、枕叶内侧面、下面及背外侧面一部分、部分间脑，以及内囊的部分血液。,1,）中央支：,从大脑后动脉的根部发出，约,5-7,小支。主要供应丘脑、 下丘脑、红核、小脑上角、大脑角外侧、内囊后支的血液。,大脑后动脉,24,.,（4 ）大脑后动脉：为基底动脉的终支，跨越动眼神经的上方，绕,2,）皮层支：,颞下前动脉,：分布于颞下回前部及背外侧面。,颞下中动脉,：分布于颞下回中部及梭状回。,颞下后动脉,：分布于楔状回后部、舌回及枕叶背外侧面。,距状裂动脉,：为大脑后动脉的终支之一，沿距状裂后行，,绕至枕级面，主要供应距状裂附近枕叶皮质。,顶枕动脉,：为大脑后动脉的终支之一，沿顶枕裂附近斜向后,上，供应楔叶以及楔前叶的后部，并绕至大脑半,球背外侧面。,颞下前动脉,颞下中动脉,颞下后动脉,距状裂动脉,顶枕动脉,25,.,2）皮层支：颞下前动脉颞下中动脉颞下后动脉距状裂动脉顶枕动脉,大脑前动脉和大脑中动脉皮层支交错供血区为额上回、额中回上半、中央前后回上,1/5,及顶间沟上缘等。,大脑后动脉的皮质支与大脑前动脉、大脑中动脉皮质支也存在侧支吻合。,26,.,大脑前动脉和大脑中动脉皮层支交错供血区为额上回、额中,大脑动脉环（,Willis,环）,27,.,大脑动脉环（Willis环）27.,大脑动脉环,-Willis circle,28,.,大脑动脉环-Willis circle28.,颈内动脉系和椎,-,基底动脉系吻合形成封闭的七边形血管环。,29,.,颈内动脉系和椎-基底动脉系吻合形成封闭的七边形血管环。29.,Willis circle,组成,大脑前动脉始部,前交通动脉,颈内动脉,后交通动脉,大脑后动脉,30,.,Willis circle组成大脑前动脉始部30.,特点,1,、位置,:,位于蝶鞍上方，围绕视交叉、灰结节、乳头体形成环状周围。,2,、作用：,沟通左右颈内动脉系统；沟通颈内动脉与椎基底动脉系统。,大脑前动脉,后交通动脉,颈内动脉,前交通动脉,大脑后动脉,31,.,特点1、位置:位于蝶鞍上方，围绕视交叉、灰结节、乳头体形成,3,、意义,（,1,）组成侧枝循环。在正常情况下，动脉环左右两侧血液不沟通，在病理情况下，特别在血管闭塞时，两侧血液相互沟通，以维持脑部的血液供应。 （,2,）调整颅内动脉压：使双侧颈内动脉系统和椎,-,基底动脉系统的血压维持平衡。,32,.,3、意义 （1）组成侧枝循环。在正常情况下，动脉环左右两,MRA,案例,33,.,MRA案例33.,34,.,34.,左颈内,/,大脑中,/,大脑前,/,椎动脉,35,.,左颈内/大脑中/大脑前/椎动脉35.,左大脑中,36,.,左大脑中36.,右大脑中,/,右大脑后 部分,37,.,右大脑中/右大脑后 部分37.,双侧大脑后 多处局限性狭窄,38,.,双侧大脑后 多处局限性狭窄38.,供血分区,39,.,供血分区39.,颅底蝶鞍层面,40,.,颅底蝶鞍层面40.,额叶,颞叶,鞍上池,脑桥,第四脑室,小脑半球,额窦,鞍上池层面,41,.,额叶颞叶鞍上池脑桥第四脑室小脑半球额窦鞍上池层面41.,第三脑室层面,42,.,第三脑室层面42.,胼胝体压部层面,43,.,胼胝体压部层面43.,胼胝体干层面,44,.,胼胝体干层面44.,MCA,终末支,ACA,终末支,PCA,终末支,半卵圆中心,半卵圆中心层面,45,.,MCA 终末支ACA终末支PCA终末支半卵圆中心半卵圆中心层,MCA,终末支,ACA,终末支,PCA,终末支,46,.,MCA 终末支ACA终末支PCA终末支46.,MCA,终末支,ACA,终末支,47,.,MCA 终末支ACA终末支47.,ACA,终末支,48,.,ACA终末支48.,案例,49,.,案例49.,左枕叶梗死,PCA,终末支,50,.,左枕叶梗死PCA终末支50.,Figure 1: (a) Normal initial CT of the patient; (b) The cranial CT two days after the incident shows signal changes consistent with simultaneous infarcts in the right MCA and PCA areas; (c) In the digital subtraction angiography of the right ICA, PCA is seen to originate from the right ICA through PCoA i.e. fetal type PCA,right MCA and PCA,51,.,Figure 1: (a) Normal initial C,PICA,On the left CT-images of a left-sided PICA-infarction.,Notice the posterior extention.,The infarction was the result of a dissection (blue arrow).,小脑后下动脉梗塞,52,.,PICA小脑后下动脉梗塞52.,On the left CT-images of a,left-sided PICA-infarction,.,In unilateral infarcts there is always,a sharp delineation in the midline,because the superior vermian branches do not cross the midline, but have a sagittal course.,This sharp delineation may not be evident until the late phase of infarction.,In the early phase, edema may cross the midline and create diagnostic difficulties.,Infarctions at,pontine level are usually paramedian,and sharply defined because the branches of the basilar arery have a sagittal course and do not cross the midline.,Bilateral infarcts are rarely observed,because these patients do not survive long enough to be studied, but,sometimes small bilateral infarcts can be seen,.,左侧小脑后下动脉梗塞,53,.,On the left CT-images of a lef,ACA,：,A1 segment: from origin to anterior communicating artery and gives rise to medial lenticulostriate arteries (inferior parts of the head of the caudate and the anterior limb of the internal capsule).,A2 segment: from anterior communicating artery to bifurcation of pericallosal and callosomarginal arteries.,A3 segment: major branches (medial portions of frontal lobes, superior medial part of parietal lobes, anterior part of the corpus callosum).,54,.,ACA：54.,Middle cerebral artery,The MCA has cortical branches and deep penetrating branches, which are called the lateral lenticulostriate arteries.,The territory of the lateral lenticulo-striate perforating arteries of the MCA is indicated with a different color from the rest of the territory of the MCA because it is a well-defined area supplied by penetrating branches, which may be involved or spared in infarcts separately from the main cortical territory of the MCA.,On the left a T2W-image of a patient with an infarction,in the territory of the middle cerebral artery (MCA).,Notice that the lateral lenticulo-striate perforating arteries of the MCA are also involved (orange arrow).,55,.,Middle cerebral artery55.,On the left images of a hemorrhagic infarction in the area of the,deep perforating lenticulostriate branches of the MCA.,大脑中动脉豆纹动脉深穿支,56,.,On the left images of a hemorr,On the left enhanced CT-images of a patient with an infarction,in the territory of the middle cerebral artery (MCA).,There is extensive gyral enhancement (luxury perfusion).,Sometimes this luxury perfusion may lead to confusion with tumoral enhancement.,大脑中动脉,57,.,On the left enhanced CT-images,Posterior cerebral artery (PCA),Deep or proximal PCA strokes cause ischemia in the thalamus and/or midbrain, as well as in the cortex.,Superficial or distal PCA infarctions involve only cortical structures (4).,On the left a patient with acute vision loss in the right half of the visual field.,The CT demonstrates an infarction in the contralateral visual cortex, i.e left occipital lobe.,左枕叶梗塞,大脑后动脉,58,.,Posterior cerebral artery (PCA,On the left three consecutive CT-images of a patient with,an occlusion of the right internal carotid artery.,The hypoperfusion in the right hemisphere resulted in multiple internal border zone infarctions.,This pattern of deep watershed infarction is quite common and should urge you to examine the carotids.,多发脑梗塞,右侧颈内动脉闭塞,59,.,On the left three consecutive,On the left another example of small infarctions in the deep borderzone and in the cortical borderzone between the MCA- and PCA-territory in the left hemisphere.,介于大脑中、,后动脉交界,60,.,On the left another example of,On the left an example of infarctions in the deep borderzone and in the cortical borderzone between the ACA- and MCA-territory.,The abnormal signal intensity in the right carotid is the result of an occlusion.,This combination of findings is so common, that once you know the pattern, you will see it many times.,介于大脑前、,中动脉交界,颈动脉闭塞,异常信号,61,.,On the left an example of infa,脉络膜前动脉供血区梗死,脉络膜前动脉,62,.,脉络膜前动脉供血区梗死脉络膜前动脉 62.,ACA,63,.,ACA63.,谢谢,64,.,谢谢64.,