脑动静脉解剖

Variations in Arterial Territories
脑动脉边缘带（交界带）
沿侧脑室背外侧角的脑室周围白质地带； 大脑前、中、后动脉交界所形成的一个卵圆形地 带； 尾状核头，此乃大脑前动脉回返支与大脑中动脉 豆纹动脉外侧丛交界处；
脑动脉边缘带（交界带）
脑的灌注压明显降低时此边缘带容易发生缺血改 变，这是由于局部血液动力学障碍所致； 低血压发生之后最易在边缘带发生脑梗死。特别 是长期高血压患者； 当低血压发生时，若脑动脉的自家调节尚未起作 用，则脑动脉内的灌注压依靠血静力压。静力压 取决于供血区与心脏的距离远近。
Communicating (C7) ICA segment Anterior choroidal artery Posterior communicating artery Tentorial branch, MHT (cut off) Meningohypophyseal trunk (MHT) Posterior genu, cavernous ICA Cavernous (C4) ICA segment Horizontal segment, petrous (C2) ICA Genu, petrous (C2) ICA Vertical segment, petrous (C2) ICA
Splenial artery
Parietooccipital artery
Calcarine artery
Superior cerebellar artery
Posterior cerebral artery
Superior cerebellar artery Pontine perforating branches, BA Left AICA-PICA trunk Anterior spinal artery
Horizontal (M1) Middle cerebral artery segment Supraclinoid internal carotid artery
Orbitofrontal (lateral frontobasal) artery Anterior temporal artery (cut across)
Fornix
Velum interpositum
Internal cerebral vein Basal vein of Rosenthal
Falcotentorial junction
Straight sinus Torcular Herophili
Superior sagittal sinus
Pontine, midbrain performating branches from basilar artery Penetrating arteries from vertebral, anterior spinal arteries Posterior inferior cerebellar arteries Anterior choroidal artery Anterior inferior cerebellar arteries Superior cerebellar artery
Parieto-occipital artery
Anterior clinoid process Left horizontal (A1) ACA
Left MCA (M1 segment) Supraclinoid ICA Distal ICA bifurcation
Basilar artery bifurcation
Posterior cerebral artery and splenial branch Superior hemispheric branches (SCA)
Superior vermian artery Great horizontal fissure, cerebellum Supratonsillar segment, PICA, with choroidal branches Inferior vermian artery (PICA) Inferior hemispheric branches (PICA) Posterior meningeal artery
Anterior communicating artery
Horizontal (A1) ACA sgments Left internal carotid artery Right internal carotid artery Right posterior communicating artery Left posterior communicating artery
Basilar artery with pontine perforating arteries Anterior medullary segment, PICA Caudal loop, lateral medullary segment, PICA
Cerebral Arterial Territory
Straight sinus Inferior sagittal sinus Sinus confluence (torcular Herophili) Occipital sinus (inconstant) Superior (top) & inferior (bottom) Petrosal sinuses Jugular bulb
卒中影像学（2）
Neuroimaging of Stroke
北京天坛医院神经放射 高培毅 薛静
2009年首医研究生 血管神经病学课程
缺血性脑卒中分期
超急性期脑梗死 急性期脑梗死 亚急性期脑梗死 早期慢性期脑梗死 晚期慢性期脑梗死 <6h 7-72h 3-10d 11d-1m >1m
Superior hypophyseal arteries Ophthalmic (C6) ICA segment Clinoid (C5) ICA segment Inferior hypophyeseal artery Anterior genu, cavernous ICA Inferolateral trunk Foramen rotundum (& artery) Foramen ovale (& artery)
Anterior cerebral arteries
Anterior cerebral arteries Middle cerebral arteries
Middle cerebral arteries Posterior cerebral arteries Posterior cerebral arteries
Basilar artery
Right AICA
Right PICA Extraspinal (V3) VA segment Intradural (V4) VA segment
Lateral posterior choroidal artery Medial posterior choroidal artery Posterior thalamoperforating arteries Superior cerebellar artery
Lateral posterior choroidal artery Pulvinar of thalamus Medial posterior choroidal artery Posterior Thalamoperforating arteries Posterior communicating artery (cut off) Posterior Communicating artery (CN3) Anterior temporal artery (cut off)
Anterior cerebral arteries Middle cerebral arteries Posterior cerebral arteries Anterior cerebral arteries
Middle cerebral arteries Posterior cerebral arteries
脑静脉和硬膜窦的特点
硬膜窦是脑静脉系统中一个特殊的结构，为坚韧 的硬脑膜围成的管道系统，内衬一层内皮细胞， 是脑静脉血和脑脊液回流的必经之路； 脑的静脉和硬膜窦内没有防止血液逆流的静脉 瓣。脑静脉开口处的瓣膜和硬膜窦内的瓣膜只是 一种改变血流方向的装置。
Superior sagittal sinus
Cortical (M4) MCA branches
Cortical (M4) MCA branches
Sylvian (lateral cerebral) fissure Insular (M2) MCA segments Medial lenticulostriate arteries Anterior cerebral artery (cut off) with medial lenticulostriate arteries Internal carotid artery
Watershed Infarcts
Lacunar Infarcts
随 诊
会 诊
脑静脉系统解剖
颅内静脉系统由脑静脉和硬膜窦构成； 幕上静脉系统和幕下静脉系统； 幕上静脉系统又可分为浅静脉和深静脉；
脑静脉和硬膜窦的特点
脑静脉管壁缺乏肌肉和弹力组织，管壁薄，管腔 大，缺乏弹性； 脑静脉绝大多数不与动脉伴行，名称也多不与动 脉名称一致； 浅、深静脉均先注入硬膜窦； 深、浅静脉组在解剖上并不是各自独立存在，无 论是在脑表面还是在脑实质内，两组静脉间均存 在着一定的吻合。
Top loops of M2 segments delineate apex of sylvian fissure Opercular (M3) MCA segments Lateral lenticulostriate arteries MCA bifurcation (genu) M1 (horizontal) MCA segment Anterior temporal artery
Precommunicating (p1) PCA segments
Basilar artery
Interhemispheric fissur Anterior communicating artery
Optic nerve Horizontal (A1) ACA segment Posterior communicating artery Horizontal (P1) PCA segment
Medial lenticulostriate arteries Thalamoperforating arteries Lateral lenticulostriate arteries
Case 1
Case 2
Case 3
Case 4
Case 5
Leabharlann Baidu
Case 6
Case 7
Case 8
Infundibular stalk, hypothalamus Middle cerebral artery (not part of COW) Optic tract Oculomotor nerve (CN3)
Basilar artery bifurcation
Anterior cerebral arteries Anterior communicating artery Right middle cerebral artery Posterior cerebral artery Superior cerebellar artery Basilar artery Left anterior inferior cerebral artery Superior vermian arteries (branches of SCA) Calcarine artery Posterior communicating artery