脑疝影像学表现说课材料.ppt

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1、脑疝影像学表现脑疝的类型：a.大脑镰疝：一侧大脑半球占位病变可使同侧扣带回经大脑镰下缘疝入对侧，胼胝体受压下移。小脑幕切迹疝b.前疝：也称颞叶沟回疝，是颞叶沟回疝于脚间池及环池的前部；②后疝：颞叶内侧部疝于四叠体池及环池的后部；f.小脑幕切迹上疝：后颅凹占位病变时，小脑上蚓部可向上疝入小脑幕切迹的四叠体池。c.中心疝：幕上压力增高，致使大脑深部结构及脑干纵轴牵张移位。d.颅外疝：脑组织通过颅外缺损疝出。e.枕骨大孔疝：后颅凹占位病变时，可致小脑扁桃体疝入枕骨大孔。g.蝶骨嵴疝：颅前凹和颅中凹的占位病

2、变，由于病变部压力相对高一些，则额眶回可越过蝶骨嵴进入颅中凹，可颞叶前部挤向颅前凹。示意图a)subfalcial(cingulate)herniation;镰下疝b)uncalherniation;钩疝c)downward(central,transtentorial)herniation;下行性小脑幕疝d)externalherniation;颅外疝e)tonsillarherniation.扁桃体疝f)ascendingtranstentorialherniation(reversedtent

3、orial)上行性小脑幕疝g)sphenoidherniation蝶骨嵴疝类型脑疝部位命名别名疝入脑组织命名1．大脑镰下疝扣带回疝2．小脑天幕疝前疝后疝小脑幕切迹疝、小脑幕下降疝脚间池疝环池疝，四叠体疝颞叶钩回疝海马回疝3．小脑幕孔中心疝间脑4．小脑幕孔上疝小脑幕上疝小脑蚓部疝5．枕骨大孔疝小脑扁桃体疝示意图解剖关系解剖关系FQcMb3vTOSyCClvFPOSpCClvss解剖关系FTCesPd4thVFTMbCesThesuprasellarcistern&thequadrigeminalcis

4、ternTheleftandcenterimagesshowthesuprasellarcistern.Itsanteriorbordersareformedbythefrontallobes(F).Itslateralbordersareformedbytheuncus(U)ofthetemporallobes.Theleftimageshowsthe5-pointedstarappearanceofthesuprasellarcisternwheretheposteriorborderisfor

5、medbythepons(Po).Theblackarrowpointstothefourthventricle.Thecenterimageshowsahighercutwherethesuprasellarcisternhasa6-pointedstarappearancesincetheposteriorborderisformedbythecerebralpeduncles(P)whichhaveacentralcleft.Therightimageshowsthequadrigeminal

6、cistern(blackarrow).Notethe"baby'sbottom"appearanceofitsanteriorborder.WhenICPisincreased,thequadrigeminalcisternspaceiscompressedorobliterated.Thesuprasellarcistern&thequadrigeminalcistern.ThemidlinesagittalMRIscanshowsthelevelsoftheaxialdiagrams.The

7、quadrigeminalcisternislocatedabove(anteriorto)the"Q"inthehighestcutshown(number9).Theanteriorborderofthequadrigeminalcisternisformedbythesuperiorcolliculi(c).Image8(lowercut)alsoshowsthequadrigeminalcistern.Inthiscase,itsanteriorborderisformedbytheinfe

8、riorcolliculi(c).Thisgivestheanteriorborderofthequadrigeminalcisterntheappearanceofa"baby'sbottom".Thequadrigeminalplateiscomprisedofthesuperiorandinferiorcolliculi.Thequadrigeminalcisternisposteriortothisquadrigeminalplate,thusitsanter