人脑桥静脉流出端的超微结构观察及其生物学意义探讨

目的描述人脑桥静脉流出端的超微结构，观察该段血管的微观形态学特征，探讨其对颅内静脉血液流出的调节机制。方法非血管源性神经系统疾病病人行开颅手术，术中小心暴露并取出脑桥静脉至近静脉窦端，常规TEM样品制备方法，选取脑桥静脉流出端行超薄切片，重金属盐染色后透射电子显微镜下观察。结果电子显微镜下可见脑桥静脉流出端有大量致密排列的纤维，以胶原纤维为主，也可见弹性纤维及少量网状纤维，散在的成纤维细胞也可在电子显微镜下发现。未发现平滑肌细胞，也未发现神经纤维组织，该血管节段电镜下超微结构特征与脑静脉系统其他部位明显不同。结论脑静脉血管床贮存的大量静脉血液可以通过容量调节影响到颅内压力变化，而脑桥静脉作为颅内静脉血液流出的最后通路，流出端具有的特殊形态学特征提示其可能是脑血液循环中静脉血液流出的关键环节。由于该段静脉血管壁没有发现平滑肌细胞，也未发现神经纤维组织，而致密分布的胶原纤维本身不具有自主舒缩功能，因此推测该段血管缺乏主动调控机制。研究脑桥静脉流出端参与静脉血液流出的被动调节机制可为下一步针对脑静脉系统临床治疗颅内压增高开辟新的研究领域。     

脑静脉系统疾病诊断与治疗进展

脑静脉系统疾病包括脑静脉系统血栓形成、静脉窦狭窄、颈内动脉海绵窦瘘和颅内动-静脉畸形等。近年来由于神经影像学和脑血管介入技术的快速发展,越来越多的脑静脉系统疾病得到及时诊断与治疗,如磁共振黑血血栓成像诊断脑静脉系统血栓形成、支架植入术治疗静脉窦狭窄、微弹簧圈联合Onyx胶栓塞术和覆膜支架植入术治疗颈内动脉海绵窦瘘等,使得对脑静脉系统疾病的研究更加深入。本文重点阐述常见脑静脉系统疾病的最新诊断与治疗进展。     

颅内静脉窦血栓形成的临床与磁共振诊断5例报告

目的分析颅内静脉窦血栓形成的临床特点,磁共振成像及磁共振血管造影对其诊断的价值。方法分析5例磁共振检查确诊的颅内静脉窦血栓形成病人的临床资料及影像学特点,其中男1例,女4例,年龄22～40岁。病后3～19天行磁共振检查,主要观察水肿、静脉性便死或出血、静脉窦内异常信号,部分病人复查时可见再通。结果5例颅内静脉窦血栓形成皆有明确原因,临床表现多样,主要为亚急性颅内压增高、抽搐、肢体瘫痪或昏迷。MRI常规SE序列T1、T2加权示窦内高信号,脑实质水肿或合并出血、硬死。磁共振脑血管造影（MRA）的PC法示静脉窦高血流信号丢失,2例分别于病后24、31天复查MRI,结果示再通。经降颅内压、抗凝、合并感染者予抗生素、激素治疗,5例均治愈。结论颅内静脉窦血栓形成是较为少见的脑血管病,且病情重,MRI／MRA可帮助确诊。早期治疗能明显改善预后。     

专题综述：伴静脉窦狭窄的特发性颅内高压的诊治

<正>编者按随着诊断技术的进步,曾认为在临床少见的特发性颅内高压(idiopathic intracranial hypertension,IIH)患者越来越多地被诊断出来,且发现相当比例的IIH患者存在脑静脉窦狭窄。颅内压增高与脑静脉窦狭窄的关系,孰因孰果至今尚无定论。脑静脉窦狭窄的原因也不完全清楚,但不论哪种原因导致的静脉窦狭窄,最终都会导致颅内静脉压力升高,造成颅内压增高,引发一系列相应症状。其中危害较     

儿童颅内静脉窦血栓形成的诊疗策略

目的探讨儿童颅内静脉窦血栓形成的高危因素、常见临床表现、影像学特征及诊疗策略。方法对2014年1月-2018年12月收住西安交通大学第一附属医院儿科的3例颅内静脉窦血栓形成患儿病例资料进行回顾性分析。结果持续而严重的头痛是颅内静脉窦血栓形成最常见的临床表现;3例患儿发病原因不一,与文献报道感染为主要原因不符,可能与病例数较少有关;影像学最常见的受累部位为乙状窦和横窦;经降颅内压、抗凝及对症治疗,1例痊愈,1例死亡,1例遗留颅神经功能异常。结论儿童以急性发作的头痛起病伴孤立性颅内压增高综合征表现者均应警惕颅内静脉窦血栓形成的可能;对脑脊液压力轻度升高的患儿仍需动态监测颅内压的变化;儿童目前推荐的影像学检查方法为颅脑磁共振成像联合磁共振静脉成像,并具有长期随访优势;全脑血管造影术在儿童中并非禁忌,在严格控制操作时间及造影剂剂量的前提下由技术熟练的专科医生操作亦是可行的;强调早期抗凝治疗,治疗药物的选择、剂量及持续时间仍有待大样本病例的研究。     

磁共振对颅内静脉窦血栓形成的诊断价值

目的分析磁共振对颅内静脉窦血栓形成的诊断价值。方法选取本院2015-02—2016-02收治的22例颅内静脉窦血栓患者,使用美国AVOTEC公司生产的3.0T磁共振视觉刺激呈现系统,对22例颅内静脉窦血栓患者行常规MRV、MRI检查,比较不同的成像序列对静脉窦血栓病变部位的显示情况。结果磁共振成像(MRI)可最直观观察静脉窦血栓病变部位及其并发症;超高场强磁共振脑静脉窦血管成像(MRV)可清晰显示出静脉窦内的堵塞情况及血栓的范围,磁共振成像及超高场强磁共振脑静脉窦血管成像联合应用对静脉窦血栓精确确诊率80%以上。结论 MR是最有效诊断静脉窦血栓的检查方法,诊断精确度高,磁共振对颅内静脉窦血栓的诊断有重要的临床价值,值得推广。     

脑静脉及静脉窦血栓形成的磁共振静脉血管成像研究进展

脑静脉及静脉窦血栓形成(cerebral vein and sinus thrombosis,CVST)是脑血管疾病的一种特殊类型,常规的影像学诊断有一定难度.磁共振静脉血管成像(magnetic resonance venography,MRV)已成为诊断CVST的主要影像学手段.目前用于诊断CVST的主要成像序列有时间飞跃血流成像(time-offlight MRV,TOF-MRV)、相位对比血流成像(Phase-Contrast MVR,PC-MRV)、三维对比增强磁共振血管血流成像(three dimensional contrast-enhanced MRV,3D CE-MRV).本文对三种MRV方法的成像原理及其在CVST诊断中的价值与潜在误诊因素作一简要综述.     

支架成形术治疗颅内静脉窦狭窄致高颅压1例报告及文献复习

<正>颅内静脉系统病变致颅内压增高患者可出现头痛、呕吐、视力障碍,也可发生脑静脉性梗死、出血,甚至危及生命。抗凝、脱水降颅压是治疗颅内静脉系统血栓形成的传统方法。但对于颅内静脉窦狭窄(venous sinus stenosis,VSS)致颅内压增高,内科药物难以从根本上解决静脉回流障碍,治疗效果不佳。我中心近期对1例颅内VSS致严重高颅压患者     

脑桥静脉对颅内压增高的调节反应

目的 研究正常和过度换气时脑桥静脉对颅内压增高的血流动力学改变。方法 选择７头丹麦白约克猪通过向枕大池灌注人工脑脊液,逐步增加颅内压,从基础值（大约１．３ｋＰａ）到２．７ｋＰａ和４．０ｋＰａ,用彩色超声多谱勒测量正常和过度换气状态下,颅内压增高对于脑桥静脉的血流速度、直径和脉冲指数的影响。结果 随着颅内压增高,脑桥静脉的血流速度减慢,直径和脉冲指数增加,而颅内压增高对中心静脉压、动脉ＣＯ２分压、平     

脑静脉窦血栓形成患者磁共振成像与磁共振静脉血管成像联合诊断的价值

目的：探讨脑静脉窦血栓（cerebral venous sinus thrombosis ,CVST ）形成患者磁共振成像与磁共振静脉血管成像联合诊断的价值。方法选取脑静脉窦血栓患者40例进行分析。诊断过程中,全体患者均接受磁共振（magnetic resonance venography ,MR）平扫,数字减影血管造影（digital subtraction angiography ,DSA）检查12例,MRV检测6例,增强扫描22例。结果单一横窦受累6例,上矢状窦、乙状窦及横窦受累8例,单一乙状窦受累16例,横窦和上矢状窦联合受累10例。所有患者磁共振成像（magnetic resonance venography ,MRI）及磁共振静脉成像（magnetic resonance venography ,MRV）均表现出信号改变。22例患者增强扫描显示脑静脉非正常强化,但静脉窦内部血栓未强化。M RV检查6例患者及DSA 12例患者的结果显示其受累静脉窦不明显、狭小、不规则,且出现侧支血管形成现象。结论 M RI与M RV联合诊断对于脑静脉窦血栓形成的诊断具有较好效果。     

颅脑桥静脉生物力学特性的研究

目的 研究颅脑桥静脉在不同应力状态下的被动调节机制及其生物力学特性之间的关系。方法 对１５例颅脑桥静脉进行充压实验,计算其在不同压力范围下的轴向及周向应力－应变关系。结果 流出口狭部的直径及长度较颅脑桥静脉的小,周向的应力－应变曲线表明颅脑桥静脉流出口狭部在周向上其硬度明显高于桥静脉。在轴向上比比较应力－应变特性时,桥静脉的硬度明显高于桥静脉流出口狭部。结论 桥静脉流出口狭部与桥静脉之间的生物力学     

Superior Sagittal Sinus Thrombosis in the Presence of Idiopathic Bilateral Internal Jugular Vein Stenosis

Cerebral venous outflow obstruction and anomalies in cerebral venous circulation predispose to dural sinus thrombosis. This case report illustrates the magnetic resonance and angiographic findings in a patient who had superior sagittal sinus thrombosis secondary to idiopathic bilateral internal jugular vein stenosis, a previously unrecognized entity. The findings suggest that bilateral stenosis of the internal jugular veins at their junction with the innominate veins causes obstruction to cerebral venous outflow leading to dural sinus thrombosis.     

Association between arterial inflow and venous outflow in idiopathic and secondary intracranial hypertension.

Twenty-four patients with a clinical diagnosis of idiopathic intracranial hypertension underwent standard magnetic resonance (MR) imaging. On the basis of MR venography, two groups of patients could be identified: (i) one group with an intrinsic venous outflow obstruction (intrinsic); and (ii) a non-intrinsically obstructed (extrinsic) group. MRI flow quantification studies of the cerebral arteries and veins, measuring arterial blood inflow as well as superior sagittal sinus (SSS) and straight sinus (ST) outflow, were performed. The MR venography confirmed that there were 12 intrinsic patients and 12 extrinsic patients. In the intrinsic group, total arterial inflow was normal; however, the SSS outflow was reduced by 35% (p=0.0001). Arterial inflow in extrinsic patients was 55% higher than normal (p=0.0001); however, the SSS flow was normal. In intrinsic venous outflow obstruction, total cerebral inflow is maintained despite a reduction in outflow. In the idiopathic cases, there was cerebral hyperaemia suggesting a derangement of autoregulation.     

MRI和MRV在脑静脉和静脉窦血栓诊断中的价值

目的探讨MRI和MRV对脑静脉和静脉窦血栓(CVST)形成的诊断价值。方法回顾性分析16例CVST患者的临床和影像学资料。结果受累的脑静脉和静脉窦有上矢状窦9例,横窦5例,直窦3例,乙状窦2例,大脑大静脉合并大脑内静脉2例。常规MRI可见受累静脉窦流空信号消失,静脉窦内信号高低不一,11例脑实质内出现静脉性脑梗死表现,其中4例合并出血。增强扫描15例静脉窦内出现充盈缺损及静脉窦壁强化表现,9例脑实质内出现脑回样强化。MRV表现为受累静脉窦部分或广泛高血流信号缺失、狭窄。结论MRI和MRV是诊断和随访CVST形成的最佳检查方法。     

静脉回流障碍与短暂性全面遗忘症的相关性

背景颈静脉回流异常被认为是短暂性全面遗忘症(transient global amnesia,TGA)的病因。既往研究报道,Valsalva动作(Valsalva maneuver,VM)期间短暂增高的胸内压或者腹内压主要是通过椎静脉系统上传及通过颈内静脉(internal jugular vein,IJV)下传,所以通畅的颈内静脉对短暂增高的颅内压力的释放及脑静脉的回流非常重要。我们假设颈内静脉受压导致的静脉回流障碍是TGA发病机制中的决定性因素。方法本研究是病例对照研究,研究对象为45例TGA者及性别/年龄相匹配的45例健康对照组。利用磁共振成像(magnetic resonance imaging,MRI),包括应用造影剂的增强轴向T1加权成像(contrastenhanced axial T1-weighted imaging,Contrast T1)与时间分辨对比剂动态成像(time-resolved imaging of contrast kinetics,TRICKS)及未应用造影剂的磁共振静脉血管成像(magnetic resonance venography,MRV),评估双侧颈内静脉与左侧头臂静脉(brachiocephalic vein,BCV)的形态及横窦(transverse sinus,TS)的不对称性,其中颈内静脉被分成上、中及下段。结果相对于对照组,TGA者双侧颈内静脉上段(左侧:37.8%vs 17.8%,P=0.0393;右侧:57.8%vs 15.6%,P0.0012)及左侧头臂静脉(60%vs 8.9%,P0.0004)中、重度狭窄/闭塞及横窦发育不良(53.3%vs 31.1%,P=0.0405)的比例显著高。病例组静脉回流的任一部位狭窄/闭塞(包括颈内静脉或者左侧头臂静脉狭窄/闭塞)的比例显著高于对照组(91.1%vs 33.3%,P0.0004)。MRV显示病例组左侧横窦的管径与对照组相比显著小([0.31±0.21)cm vs(0.41±0.19)cm,P=0.0290],而Contrast T1显示病例组左侧横窦的管径与对照组无显著差异,此结果与回流静脉存在近心端狭窄/闭塞相符。结论头颈静脉回流障碍是TGA的重要发病机制;双侧颈内静脉和(或)左侧头臂静脉狭窄/闭塞及横窦发育不良是导致头颈静脉回流障碍的重要因素。     

Supratentorial pressures. Part II: Intracerebral pulse waves

Intracerebral pulse waves were recorded in cat and monkey while intracranial pressure (ICP) manipulations were performed. The intracerebral pulse waves appeared comparable to cerebrospinal fluid (CSF) pulsations. The wave forms were divided into multiple smaller waves, designated P1 to P4. The P1 component was primarily of arterial origin and was accentuated by increasing ICP unrelated to increased venous pressure, most commonly from a mass lesion. Bilateral carotid occlusion resulted in decreased amplitude of P1. Venous hypertension from jugular venous or sagittal sinus occlusion, on the other hand, accentuated waves P2 and P3 more than P1. This is consistent with a Starling resistor model of the cerebral venous system in which mass lesions may compress low-pressure veins and accentuate the arterial pressure-dependent P1 wave, whereas venous hypertension causes increased prominence of the later P2 and P3 waves.     

高分辨磁共振血管壁成像3D CUBE T_1序列与SWI诊断颅内静脉窦血栓的对比研究

目的通过联合应用颅脑常规MRI、高分辨磁共振血管壁成像3D CUBE T_1序列及SWI对颅内静脉窦及其内血栓的显像,评价3D CUBE T_1序列和SWI对颅内静脉窦血栓(cerebral venous sinus thrombosis,CVST)的诊断效能及应用价值。方法本研究为前瞻性研究,连续纳入山东第一医科大学第一附属医院神经内科2016年3月-2017年9月临床疑诊CVST的34例患者。行颅脑MRI平扫、MRV、SWI、3D CUBE T_1序列检查。将颅脑平扫与MRV的诊断结果作为确诊CVST的参照诊断,应用ROC曲线分析评估3D CUBE T_1序列及SWI在患者及静脉窦血管节段水平诊断CVST的敏感性、特异性。结果以参照诊断为依据评判CVST的阳性患者共9例,共累计24处病变静脉窦节段。3D CUBE T_1序列在患者水平诊断CVST的敏感度和特异度分别为100%和95.2%,ROC曲线下面积为0.98;在静脉窦节段水平诊断CVST的敏感度和特异度分别为95.8%和97.7%,ROC曲线下面积为0.97。SWI在患者水平诊断CVST的敏感度和特异度分别为66.7%和76.2%,ROC曲线下面积为0.71;在静脉窦节段水平诊断CVST的敏感度和特异度分别为70.8%和95.4%,ROC曲线下面积为0.83。结论与SWI相比,高分辨磁共振血管壁成像3D CUBE T_1序列对CVST的诊断具有更高的敏感性及特异性,准确性高,能够为CVST的临床诊断及治疗提供可靠的诊断信息,具有很好的临床实用价值及应用前景。     

Cerebral blood flow autoregulation during intracranial hypertension: a simple, purely hydraulic mechanism?

Objective  In this paper, we re-propose the role of a hydraulic mechanism, acting where the bridging veins enter the dural sinuses in cerebral blood flow (CBF) autoregulation. Materials and methods  We carried out an intraventricular infusion in ten albino rabbits and increased intracranial pressure (ICP) up to arterial blood pressure (ABP) levels. We measured CBF velocity by an ultrasound probe applied to a by-pass inserted in a carotid artery and recorded ICP by an intraventricular needle. Diastolic and pulsatile ICP and ABP values were analyzed from basal conditions up to brain tamponade and vice versa. Conclusions  A biphasic pattern of pulsatile intracranial pressure (pICP) was observed in all trials. Initially, until the CBF velocity remained constant, pICP increased (from 1.2 to 5.4 mmHg) following a rise in diastolic intracranial pressure (dICP); thereafter, in spite of a further rise in dICP, pICP decreased (2.87 mmHg) following CBF velocity reduction until intracranial circulation arrest (pICP = 1.2 mmHg). A specular pattern was observed when the intraventricular infusion was stopped and CBF velocity returned to basal levels. These findings can be interpreted as indicating a hydraulic mechanism. Initially, when CBF is still constant, pICP rise is due to an increase in venous outflow resistance; subsequently, when CBF decreases following a further increase in venous outflow resistance, the vascular engorgement produces an arteriolar vasodilation. This vasodilation determines an increase in vascular wall stiffness, thus reducing pulse transmission to surrounding subarachnoid spaces. Commentaries on this paper are available at doi: and doi: .