1、脑和脊髓的被膜、血管及脑脊液循环脑和脊髓的被膜、血管及脑脊液循环The Meninges of Brain and Spinal CordThe 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. 脑和脊髓的表面均包有三层被膜，由脑和脊髓的表面均包有三层被膜，由外向内依次为外向内依次为硬膜、蛛网膜、软膜硬膜、蛛网膜、软膜，具有，具有保护、支持脑和
2、脊髓的作用。保护、支持脑和脊髓的作用。 硬膜厚而坚韧，分为硬脊膜和硬脑膜。硬膜厚而坚韧，分为硬脊膜和硬脑膜。( (一一) )硬膜硬膜1 1、硬脊膜硬脊膜spinal dura mater 硬膜外隙硬膜外隙epidural spaceepidural space：硬：硬脊膜与椎骨内面的骨膜之间的间隙，脊膜与椎骨内面的骨膜之间的间隙，有脊神经根通过，不与颅内相通。有脊神经根通过，不与颅内相通。硬膜外麻醉时就是将麻药注入此隙硬膜外麻醉时就是将麻药注入此隙内，起到阻滞脊神经传导的作用。内，起到阻滞脊神经传导的作用。The meninges of spinal cord nSpinal dura mat
3、er 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 du
4、ra mater and periosteum of vertebral canal nContents: a quantity of loose connective tissue, fat, lymphatic vessels and vertebral venous plexus, the spinal nerves nSubdural space硬膜下隙硬膜下隙Spinal arachnoid mater 脊髓蛛网膜脊髓蛛网膜 CharactersnA thin, delicate, tubular membran loosely investing spinal cordnAbove
5、, it is continuous with cerebral arachnoid materSubarachnoid space 蛛网膜下隙蛛网膜下隙Position: lies between pia and arachnoid maters containing cerebrospinal fluidTerminal cistern 终池终池: the largest part of subarachnoid space extending from termination of spinal cord to level of S2Lumbar spinal puncture (spi
6、nal tap) Spinal pia mater 软脊膜软脊膜A delicate vascular membrane that closely invests the spinal cordDenticulate ligament齿状韧带齿状韧带Filum 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2、硬脑膜、
7、硬脑膜cerebral dura mater组成组成颅骨内膜颅骨内膜硬脑膜硬脑膜愈合而成愈合而成特点：在颅顶与颅盖骨结合疏松，易分特点：在颅顶与颅盖骨结合疏松，易分离；在颅底结合牢固。离；在颅底结合牢固。形成的结构：包括形成的结构：包括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 calva
8、ria, and most strongly adherent to base of skull下矢状窦下矢状窦横窦横窦直窦直窦岩上窦岩上窦岩下窦岩下窦颈内动脉颈内动脉视神经视神经漏斗漏斗鞍隔鞍隔海绵窦海绵窦蝶顶窦蝶顶窦大脑大静脉大脑大静脉小脑幕切迹小脑幕切迹小脑幕小脑幕上矢状窦上矢状窦大脑镰大脑镰岩上窦岩上窦乙状窦乙状窦横窦横窦窦汇窦汇硬脑膜图硬脑膜图大脑镰：呈镰刀状，伸入大脑纵裂。大脑镰：呈镰刀状，伸入大脑纵裂。小脑幕：呈半月形，位于大脑与小脑之间。小脑幕：呈半月形，位于大脑与小脑之间。小脑幕切迹：小脑幕前缘游离，围绕中脑。小脑幕切迹：小脑幕前缘游离，围绕中脑。造成小脑幕切迹疝或海马旁回疝
9、。造成小脑幕切迹疝或海马旁回疝。鞍隔：在蝶鞍上面，封闭垂体窝，中央有一小鞍隔：在蝶鞍上面，封闭垂体窝，中央有一小孔，有漏斗通过。孔，有漏斗通过。Four septa nCerebral falx 大脑镰大脑镰nTentorium of cerebellum小脑幕小脑幕ntentorial incisure 幕切迹幕切迹, nCerebellar falx 小脑镰小脑镰nDiaphragma sellae 鞍隔鞍隔直窦直窦眼神经眼神经垂体垂体基底丛基底丛海绵窦海绵窦三叉神经三叉神经展神经展神经滑车神经滑车神经动眼神经动眼神经蝶顶窦蝶顶窦横窦横窦乙状窦乙状窦岩上窦岩上窦大脑大静脉大脑大静脉小脑幕小
10、脑幕硬脑膜窦硬脑膜窦 颅底内面图颅底内面图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 下矢状窦下矢状窦横窦横窦直窦直窦岩上窦岩上窦岩下窦岩下窦颈内动脉颈内动脉视神经视神经漏斗漏斗鞍隔鞍隔海绵窦海绵窦蝶顶窦蝶顶窦大脑大静脉大脑大静脉小脑幕切迹小脑幕切迹小脑幕小脑幕上矢状窦上矢状窦大脑镰大脑镰岩上窦岩上窦乙状窦乙状窦横窦横窦窦汇窦汇硬脑膜图硬脑膜图nTran
11、sverse 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 岩下窦岩下窦海绵窦海绵窦Cavernous sinus 位于蝶鞍两侧，形似海绵。位于蝶鞍两侧，形似海绵。穿过海绵窦的结构：颈内动脉、展神经穿过海绵窦的结构：颈内动脉、展神经通过海绵窦外侧壁的结构由上向下：通过海绵窦外侧壁的结构由上向下： 动眼神经、滑车神经、三叉神经的眼神动眼神经、滑车神经、三叉神经的眼神经及上颌神经。经及上颌神经。海绵窦的交通：海绵窦的交通：1 1、借眼静脉与面静脉交通、借眼静脉与
12、面静脉交通2 2、通过板障静脉和顶导静脉与颅外静、通过板障静脉和顶导静脉与颅外静脉交通。脉交通。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 ner
13、ve lie in the lateral wall of the sinus海海绵绵窦窦冠冠状状断断面面蝶窦蝶窦眼神经眼神经垂体垂体视束视束海绵窦海绵窦颈内动脉颈内动脉上颌神经上颌神经展神经展神经滑车神经滑车神经动眼神经动眼神经颈内动脉颈内动脉硬脑膜窦内的血液流向硬脑膜窦内的血液流向The flowing of the blood in dural sinus 下矢状窦下矢状窦直窦直窦颈内静脉颈内静脉岩上窦岩上窦窦汇窦汇横窦横窦乙状窦乙状窦岩下窦岩下窦海绵窦海绵窦上矢状窦上矢状窦 Sup. sagittal sinus Inf. sagittal sinus Straight sinus C
14、onfluence of sinus Transverse sinus Cavernous sinus Sup. petrosal sinus Inf. petrosal sinus Internal jugular vein Sigmoid sinus位于硬膜的深面，为无血管的半透明薄膜位于硬膜的深面，为无血管的半透明薄膜。(二二)蛛网膜蛛网膜arachnoid mater 蛛网膜下隙蛛网膜下隙：蛛网膜与软膜之间的腔隙。：蛛网膜与软膜之间的腔隙。蛛网膜下池蛛网膜下池：蛛网膜下隙在某些部位扩大。：蛛网膜下隙在某些部位扩大。小脑延髓池小脑延髓池：位于小脑和延髓之间：位于小脑和延髓之间终池终池：位
15、于脊髓末端与第二骶椎水平之间，内无：位于脊髓末端与第二骶椎水平之间，内无脊髓，只有马尾。抽取脑脊液常在上述两池进行穿刺脊髓，只有马尾。抽取脑脊液常在上述两池进行穿刺 脚间池及交叉池脚间池及交叉池：蛛网膜粒蛛网膜粒：蛛网膜在上矢状窦处形成绒毛状突起，：蛛网膜在上矢状窦处形成绒毛状突起，突入上矢状窦内，脑脊液可经此渗入至静脉窦内突入上矢状窦内，脑脊液可经此渗入至静脉窦内Cerebral arachnoid mater 脑蛛网膜脑蛛网膜nCharacters: na delicate membrane covering brain loosely, passing over sulci and en
16、tering 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 cisternsCerebellomedullary cistern 小脑延髓池小脑延髓池Interpeduncular cistern 脚间池脚间池Pontine cistern 桥池
17、桥池Superior 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 （一）脑室系统（一）脑室系统位于脑内的腔隙，包括：位于脑内的腔隙，包括：1 1、侧脑室：分为中央部、前角、侧脑室：分为中央部、前角、 后角、侧角后角、侧角2 2、第三脑室：位于两侧间脑之间、
18、第三脑室：位于两侧间脑之间3 3、第四脑室：位于延髓、脑桥、第四脑室：位于延髓、脑桥 和小脑之间和小脑之间小脑延髓池小脑延髓池室间孔室间孔中脑水管中脑水管正中、外侧孔正中、外侧孔二、脑室系统、脑脊液及其循环途径二、脑室系统、脑脊液及其循环途径（二）脑脊液及其循环途径（二）脑脊液及其循环途径 脑脊液是由脑室脉络丛产生的无色透明液体，总量达100160ml功能: 1、维持渗透压和颅内压2、营养脑，运走代谢产物3、缓冲外力，减少震荡。脑脑脊脊液液循循环环途途径径图图蛛网膜蛛网膜蛛网膜粒蛛网膜粒上矢状窦上矢状窦软脑膜软脑膜大脑镰大脑镰侧脑室脉络丛侧脑室脉络丛上矢状窦上矢状窦第三脑室脉络丛第三脑室脉络丛
19、室间孔室间孔脚间池脚间池交叉池交叉池硬脑膜硬脑膜大脑大静脉大脑大静脉蛛网膜粒蛛网膜粒硬脑膜硬脑膜第四脑室正中孔第四脑室正中孔中脑水管中脑水管小脑延髓池小脑延髓池蛛网膜下隙蛛网膜下隙终池终池左、右侧脑室左、右侧脑室左、右室间孔左、右室间孔第三脑室第三脑室中脑水管中脑水管第四脑室第四脑室上矢状窦上矢状窦窦汇窦汇横窦横窦乙状窦乙状窦脑脊液循环途径演示脑脊液循环途径演示正中孔正中孔外侧孔外侧孔小脑延髓池小脑延髓池蛛网膜下隙蛛网膜下隙蛛网膜粒蛛网膜粒颈内静脉颈内静脉Circulation of cerebrospinal fluid (CSF) nCerebrospinal fluid is a cle
20、ar 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 fro
21、m lateral ventricleInterventricular foraminathird ventriclemesencephalic aqueductfourth ventriclemedian and two lateral aperturessubarachnoid spacearachnoid granulationsSuperior sagittal sinusvein（一）脑的动脉（一）脑的动脉来源来源颈内动脉系颈内动脉系：椎基底动脉系椎基底动脉系：分支分支皮质支皮质支中央支中央支供应大脑半球后供应大脑半球后1/31/3和脑干、小脑、间和脑干、小脑、间脑后半部。脑后半部。
22、三、脑和脊髓的血液供应三、脑和脊髓的血液供应供应大脑半球前供应大脑半球前2/32/3和和间脑前半部。间脑前半部。1 1、颈内动脉、颈内动脉Internal carotid artery 走行：走行：虹吸部：颈内动脉的海绵窦内虹吸部：颈内动脉的海绵窦内段和前床突上段，呈段和前床突上段，呈U U型。型。分支分支大脑前动脉大脑前动脉大脑中动脉大脑中动脉脉络丛前动脉脉络丛前动脉后交通动脉后交通动脉2 2、椎动脉、椎动脉Vertebral artery 走行：在脑桥延髓交界处左、右走行：在脑桥延髓交界处左、右椎动脉汇合成基底动脉椎动脉汇合成基底动脉分支分支小脑下后动脉小脑下后动脉小脑下前动脉小脑下前动脉
23、迷路动脉迷路动脉脑桥动脉脑桥动脉小脑上动脉小脑上动脉大脑后动脉大脑后动脉Arteries 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 cerebellum脑脑底底面面的的动动脉脉图图脊髓小脑后束脊髓
24、小脑后束颈内动脉颈内动脉后交通动脉后交通动脉前交通动脉前交通动脉展神经展神经视神经视神经大脑中动脉大脑中动脉脊神经节脊神经节大脑前动脉大脑前动脉小脑上动脉小脑上动脉椎动脉椎动脉动眼神经动眼神经舌下神经根舌下神经根大脑后动脉大脑后动脉脊髓前动脉脊髓前动脉垂体垂体小脑下前动脉小脑下前动脉小脑下后动脉小脑下后动脉脑桥动脉脑桥动脉迷路动脉迷路动脉基底动脉基底动脉脊髓后动脉脊髓后动脉Internal 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 nAnterio
25、r 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大脑前动脉图大脑前动脉图大脑前动脉大脑前动脉胼胝体缘动脉胼胝体缘动脉额后内侧支额后内侧支大脑中动脉大脑中动脉额前内侧支额前内侧支额胶内侧支额胶内侧支额底内侧动脉额底内侧动脉顶枕支顶枕支距状沟支距状沟支大脑后动脉大脑后动脉颞后支颞后支颞中间内侧支颞中间内侧支胼胝体周围动脉胼胝体周围动脉颞前支颞前支楔前动脉楔前动脉中央旁动脉中央旁动脉Cortical branches: supply all medial surface of the cerebral
26、cortex Central branches: supply caudate nucleus, anterior part of lentiform nucleus and anterior limb of internal capsuleAnterior cerebral artery大脑前动脉大脑前动脉顶后动脉顶后动脉角回动脉角回动脉中央后沟动脉中央后沟动脉颞后动脉颞后动脉中央沟动脉中央沟动脉鼻侧纤维鼻侧纤维颞中间动脉颞中间动脉大脑中动脉大脑中动脉额底外侧动脉额底外侧动脉中央前沟动脉中央前沟动脉颞前动脉颞前动脉大脑中动脉图大脑中动脉图大脑中央动脉大脑中央动脉皮质支皮质支苍白球苍白球背侧丘
27、脑背侧丘脑尾状核尾状核内侧支内侧支内囊内囊壳壳大脑中动脉大脑中动脉中央支中央支外侧支外侧支大脑中央动脉大脑中央动脉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)Middle cerebral arter
28、y大脑中动脉大脑中动脉It supplies lateral geniculate body, posterior limb of internal capsule, middle 3/5 of crus cerebri,and globus pallidusAnterior choroidal artery脉络丛前动脉脉络丛前动脉:Posterior communicating artery后交通动脉：后交通动脉：runs backward to join posterior cerebral arteryCranial branchesAnterior and posterior spin
29、al arteries 脊髓前、后动脉脊髓前、后动脉Posterior inferior cerebellar artery 小脑下后动脉小脑下后动脉Branches of basilar arteryAnterior inferior cerebral artery小脑下前动脉小脑下前动脉Labyrinthine artery 迷路动脉迷路动脉Pontine arteries 脑桥动脉脑桥动脉Superior cerebellar artery 小脑上动脉小脑上动脉Posterior cerebral artery 大脑后动脉大脑后动脉 Vertebral artery 椎动脉椎动脉Post
30、erior cerebral arteryCortical branches: supply medial and inferior surfaces of temporal lobe and occipital lobeCentral branches: supply dorsal thalamus, medial and lateral geniculate bodies, hypothalamus and subthalamus3 3、大脑动脉环、大脑动脉环circle of Willis 组成组成：由前交通动脉、两侧大脑前动脉起：由前交通动脉、两侧大脑前动脉起始段、两侧颈内动脉末段、两
31、侧后交通动脉和始段、两侧颈内动脉末段、两侧后交通动脉和两侧大脑后动脉起始段共同组成。两侧大脑后动脉起始段共同组成。位置位置：位于脑底下方，在蝶鞍上方围绕这：位于脑底下方，在蝶鞍上方围绕这视交叉、灰结节及乳头体周围形成环状。视交叉、灰结节及乳头体周围形成环状。意义意义：通过大脑前、中、后动脉的吻合，：通过大脑前、中、后动脉的吻合，使两侧颈内动脉系与椎基底动脉系血液沟通，使两侧颈内动脉系与椎基底动脉系血液沟通，对调节脑血流量及代偿作用。对调节脑血流量及代偿作用。 大脑动脉环大脑动脉环( circle of Willis )Cerebral arterial circlenFormation: fo
32、rmed 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 （二）脑的静脉（二）脑的静脉分浅、深静脉系统，不与动脉伴行，分浅、深静脉系统，不与动脉伴行
33、，注入硬脑膜窦。注入硬脑膜窦。大脑浅静脉大脑浅静脉： 收集皮质及皮质下收集皮质及皮质下髓质的静脉血。分大脑上静脉、大脑中髓质的静脉血。分大脑上静脉、大脑中浅静脉和大脑下静脉三组。浅静脉和大脑下静脉三组。大脑深静脉大脑深静脉：收集大脑深部髓质、：收集大脑深部髓质、基底核及间脑的静脉血。汇合成两侧大基底核及间脑的静脉血。汇合成两侧大脑内静脉，再汇合成一条大脑大静脉，脑内静脉，再汇合成一条大脑大静脉，注入直窦。注入直窦。大脑的静脉Veins of brainSuperficial cerebral veins nDrain blood from cortex and subcortical medu
34、llary 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 sinus（三）脊髓的动脉（三）脊髓的动脉来源：来源：1 1、椎动脉、椎动脉2 2、节段性
35、动脉、节段性动脉：如肋间动：如肋间动脉、腰动脉、骶外侧动脉的脊髓支脉、腰动脉、骶外侧动脉的脊髓支危险区：危险区： T1-4 T1-4 、L1L1（四）脊髓的静脉（四）脊髓的静脉脊髓前动脉脊髓前动脉脊髓后动脉脊髓后动脉脊髓的被膜和血管图脊髓的被膜和血管图Blood 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 ) 脊脊髓髓的的血血管管 Blood vessels of spinal cordSpinal veins: drain into internal vertebral venous plexus
