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2。zhǒng) 硬膜下隙(硬膜下出血) 蛛網(wǎng)膜下隙(蛛網(wǎng)膜下腔出血),第三十三頁,共七十六頁。,小腦(xiǎonǎo)幕切跡疝,枕骨(zhěngǔ)大孔疝,疝的原因、位置、壓迫(yāp242。)結(jié)構(gòu)、臨床表現(xiàn)?,第三十四頁,共七十六頁。,第三十五頁,共七十六頁。,蝶鞍區(qū) 指顱中窩中央部的蝶鞍及其周圍的區(qū)域(qūy249。) 主要結(jié)構(gòu): 蝶鞍、 垂體hypophysis 鞍隔diaphragma sellae 視神經(jīng)與視交叉optic n. and chiasma 海綿竇cavernous sinus,第三十六頁,共七十六頁。,垂體Hypophysis 位于鞍膈與垂體窩之間 上方:鞍隔被覆,鄰視交叉、漏斗 外側(cè)(w224。i c232。):海綿竇組織及其內(nèi)的頸內(nèi)動脈相鄰 下方:蝶骨垂體窩,第三十七頁,共七十六頁。,垂體與視交叉的位置(w232。i zhi)關(guān)系,垂體腫瘤會可能導(dǎo)致視覺的什么(sh233。n me)改變?,第三十八頁,共七十六頁。,海綿竇Cavernous sinus 位于(w232。iy)蝶鞍與蝶竇的兩側(cè) 海綿間竇,第三十九頁,共七十六頁。,毗鄰(p237。l237。n)及穿行結(jié)構(gòu):外側(cè)壁:III、IV、VV2 內(nèi)側(cè)壁:與垂體相鄰 竇腔內(nèi):頸內(nèi)動脈、VI,Oculomotor n Trochlear n Ophthalmic n Maxillary n Hypophysis Internal carotid a Abducent n,第四十頁,共七十六頁。,第四十一頁,共七十六頁。,海綿(hǎimi225。n)竇的交通,第四十二頁,共七十六頁。,海綿(hǎimi225。n)竇綜合征cavernous syndrome?,受刺激 麻痹(m225。b236。) Oculomotor n.動眼神 Trochlear.滑車神經(jīng) Ophthalmic n.眼神經(jīng) ? Maxillary n.上頜神經(jīng) Ophthalmic v.眼靜脈,博動性突眼palpitation goggleeyed:海綿(hǎimi225。n)竇段頸內(nèi)動脈瘤破裂,第四十三頁,共七十六頁。,1.4 顱內(nèi)外靜脈(j236。ngm224。i)交通,通過(tōnggu242。)面靜脈與翼叢的交通,通過(tōnggu242。)導(dǎo)靜脈的交通,眼上V,海綿竇,眼下V,卵圓孔V,破裂孔V,翼叢,面V,頸內(nèi)V,,通過板障靜脈的交通,第四十四頁,共七十六頁。,第四十五頁,共七十六頁。,Disscussion of cases 1,During batting practice of ball was foultipped and struck the left side of the head of a player standing nearby. He fell to the ground and was unconscious for more than 3 minutes. The initial examination by the trainer revealed that the skin was not broken, but there was a swelling in the temporal fossa.The player complained of an intense headache, disorientation, and blurred vision.His left pupil was moderateld diated and reacted sluggishly to light.一學(xué)生在進(jìn)行棒球練習(xí)時受到惡意攻擊,旁邊的人擊中其左側(cè)頭部,他當(dāng)即倒地,神志不清達(dá)三分多鐘。教練(ji224。oli224。n)初步檢查發(fā)現(xiàn)未有頭皮破損,但顳窩有一腫塊。傷者訴劇烈頭痛,辨不了方向,視物模糊。其左側(cè)瞳孔中度擴大,對光反應(yīng)遲鈍。,第四十六頁,共七十六頁。,Clinicoanatomical Problems,Which of the signs mentioned above indicate a possible cranial fracture and extradural hematoma?(上述那些表現(xiàn)提示有顱骨骨折和硬膜外血腫?) What arterial branch was most likely torn?Where is it located?(那條動脈最可能破裂?)What type of cranial fracture is likely present?Where would the blood accumolate? (象那類顱骨骨折) If you were present at the time of injury and