giai phau than kinh doi chieu cdha gs thong
TRANSCRIPT
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Gi¶i phÉu thÇn kinh ®èi chiÕuchÈn ®o¸n H×nh ¶nh
TS Ph¹m Minh Th«ng
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Gi¶i phÉu nhu m« n·oGi¶i phÉu nhu m« n·o
1.Thuú tr¸n2.Thuú ®Ønh3.Thuú chÈm4.Thuú th¸i d- ¬ng5.R·nh Rolando
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C¸c thuú n·oC¸c thuú n·o
Gi¶i phÉu nhu m« nÿo
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C¸c thuú n·oC¸c thuú n·o
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Gi¶i phÉu nhu m« n·oGi¶i phÉu nhu m« n·oNh©n x¸m trung t©mNh©n x¸m trung t©m
Gi¶i phÉu nhu m« n·oGi¶i phÉu nhu m« n·oNh©n x¸m trung t©mNh©n x¸m trung t©m
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HÖ thèng n·o thÊtHÖ thèng n·o thÊtHÖ thèng n·o thÊtHÖ thèng n·o thÊt
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HÖ thèng n·o thÊtHÖ thèng n·o thÊtHÖ thèng n·o thÊtHÖ thèng n·o thÊt
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C¸c bÓ n·o vµ khoang d- íi nhÖnC¸c bÓ n·o vµ khoang d- íi nhÖnC¸c bÓ n·o vµ khoang d- íi nhÖnC¸c bÓ n·o vµ khoang d- íi nhÖn
1 – BÓ tuû tr- íc
2 – BÓ lín
3 –BÓ quanh cÇu
4 – BÓ tiÓu n·o trªn
5 – BÓ gi÷a c¸c n·o
6 – BÓ trªn yªn
7 – BÓ quanh cuèng
8 – BÓ cñ n·o sinh t-
9 - Velum interpositum
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Xoang hangXoang hangXoang hangXoang hang
1.TuyÕn yªn2.Cuèng3.d©y TK III4.D©y IV5.D©y VI7.Xoang b- ím8.§M c¶nh trong9.PhÇn tr- íc b¶n dèc10.N·o thÊt III11.Giao thoa thÞ gi¸c12.BÓ trªn yªn13.C¸c khoang XH15.Vïng d- íi ®åi16.D©y V217.Di©phm tuyÕn yªn
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Mµng n·oMµng n·oMµng n·oMµng n·o
1. Vßm sä
2. Mµng cøng
3.Mµng nhÖn
4. Mµng mµng mÒm
5. b¸n cÇu ®¹i n·o
Khoang ngoµi mµng cøng (gi÷a1-2)
Khoang d- íi mµng cøng(gi÷a 2-3)
Khoang d- íi nhÖn ( gi÷a 3-4)
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Mµng n·oMµng n·oMµng n·oMµng n·o
Mµng cøng : - LiÒm n·o(faux du cerveau)- LÒu tiÓu n·o- lÒu vµ di©phm tuyÕn yªn
• Khoang ngoµi mµng cøng : - Khoang ¶o- Gi÷a vßm sä vµ mµng cøng
• Khoang d- íi mµng cøng: - Gi÷a mµng cøng vµ mµng nhÖn
• Khoang d- íi nhÖn : - gi÷a mµng nhÖn vµ mµng mÒm- t¹o t¸c bÓ n·o- Th«ng víi hÖ thèng n·o thÊt:
. C¸c lç Magendie.C¸c lç Luscka
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12Mµng n·oMµng n·oMµng n·oMµng n·o
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Mµng n·oMµng n·oMµng n·oMµng n·o
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XoangXoangtÜnh m¹chtÜnh m¹ch
XoangXoangtÜnh m¹chtÜnh m¹ch
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Mµng cøng vµ xoang tÜnh m¹chMµng cøng vµ xoang tÜnh m¹chMµng cøng vµ xoang tÜnh m¹chMµng cøng vµ xoang tÜnh m¹ch
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HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch c¶nh ngoµiéng m¹ch c¶nh ngoµi
HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch c¶nh ngoµiéng m¹ch c¶nh ngoµi
1.§éng m¹ch gi¸p trªn2.§M hÇu lªn3.§M l- ìi4.§M mÆt5.§M chÈm6.§M tai sau7.§M th¸i d- ¬ng n«ng8.§M hµm trong9.§M c¶nh trong
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HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch c¶nh trongéng m¹ch c¶nh trongHÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u
§§éng m¹ch c¶nh trongéng m¹ch c¶nh trong
1.§M c¶nh trong ®o¹n cæ2.Th©n mµng cøng hè yªn3.Th©n d- íi bªn4,§M m¾t5.§M th«ng sau6.§M n·o sau
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HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch n·oéng m¹ch n·o
HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch n·oéng m¹ch n·o
§m c¶nh trong th¼ng1.Bê trªn x- ¬ng ®¸2.Bê trªn hèc m¾t3.§MCT trong x- ¬ng ®¸4.Xiph«ng5.§o¹n trong bÓ n·o cña MMT6.§o¹n trong n·o thÊt7.A1 §MNT8.§o¹n A29.§o¹n M110.C¸c §M bÌo v©n11.§o¹n M2.
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HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch n·oéng m¹ch n·o
HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch n·oéng m¹ch n·o
T- thÕ nghiªng1.Xiph«ng2.§M n·o sau3.§M n·o tr- íc4.§M quanh thÓ trai5.§M viÒn thÓ trai6.Nh¸nh vá n·o lªn
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HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch sèng nÒnéng m¹ch sèng nÒnHÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch sèng nÒnéng m¹ch sèng nÒn
1.§M sèng2.§M tuû sèng tr- íc3.§M tiÓu n·o sau d- íi4.§M th©n nÒn5.§M tiÓu n·o tr- íc d- íi6.C¸c nh¸nh xiªn c©u n·o7.§M n·o sau.
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HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch n·oéng m¹ch n·o
HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch n·oéng m¹ch n·o
1.§m sèng; 2.§M tiÓu n·o sau d- íi(PICA); 3.§M th©n nÒn4.§M tiÓu n·o tr- íc d- íi, 5.§M tiÓu n·o trªn; 6. §M n·o sau
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HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch n·oéng m¹ch n·o
HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§éng m¹ch n·oéng m¹ch n·o
1.§m sèng; 2.§M tiÓu n·o sau d- íi(PICA); 3.§M th©n nÒn4.§M tiÓu n·o tr- íc d- íi, 5.§M tiÓu n·o trªn; 6. §M n·o sau
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HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§a gi¸c Willisa gi¸c Willis
HÖ thèng m¹ch m¸uHÖ thèng m¹ch m¸u§§a gi¸c Willisa gi¸c Willis
1.§M c¶nh trong2.§o¹n A1 §M n·o tr- íc3.§M th«ng tr- íc4.§M th«ng sau5.§o¹n P1 §M n·o sau6.§M th©n nÒn7.§M n·o gi÷a8.§M sèng9.Giao thoa thÞ gi¸c
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SCANNER IRMIRM
33 Dïng tia xDïng tia x 33 Kh«ng dïng tia XKh«ng dïng tia X
33 C¾t ngang víi t¸i t¹o däcC¾t ngang víi t¸i t¹o däc 33 NhiÒu h- íngNhiÒu h- íng
33 §§é nh¹y caoé nh¹y cao
33 nghiªn cøu x- ¬ng tètnghiªn cøu x- ¬ng tèt 33 ThÊy m¹ch m¸u (ARM)ThÊy m¹ch m¸u (ARM)
33 CÇn thuèc c¶n quangCÇn thuèc c¶n quang
®Ó thÊy èng tuû, m¹ch®Ó thÊy èng tuû, m¹ch
33 Thuèc ¸i tõThuèc ¸i tõ
33 Gi¸ rÎGi¸ rÎ 33 §§¾t h¬n¾t h¬n
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IRMIRMIRMIRM
¦u thÕ --Kh«ng bøc x¹ i on- H×nh ¶nh nhiÒu mÆt ph¼ng-§é nh¹y víi tæ chøc . CT-Xung :
T1 : Cêu trócT2 : h×nh gièng ’Myªlo’
Tæ chøc ++-Thuèc Gadolinium : Ph¸t hiÖn tæn th- ¬ng nhu m«-Angio-IRM hay ARM +++
BÊt lîi - Ng- êi mang m¸y t¹o nhÞp-Clip m¹ch m¸u
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C¸c líp c¾tC¸c líp c¾tC¸c líp c¾tC¸c líp c¾t
üüAxialAxial¯̄ §§- êng lç tai hèc m¾t (OM)- êng lç tai hèc m¾t (OM)
OM : 0OM : 0°°
¯̄ Plan neuroPlan neuro--oculaire (PNO)oculaire (PNO)OM :OM : -- 1515°°
üücoronalcoronalOM : +80OM : +80°°
üüsagittalsagittal
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S¬ ®å c¸c líp c¾t ngang+MP tr¸nS¬ ®å c¸c líp c¾t ngang+MP tr¸n
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Plan NeuroPlan Neuro--Oculaire (PNO)Oculaire (PNO)Plan NeuroPlan Neuro--Oculaire (PNO)Oculaire (PNO)
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Gi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·o
TDM :
1 – Xoang däc trªn
2 – LiÒm n·o
3 – ChÊt x¸m
4-ChÊt tr¾ng
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Gi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·o
TDM & IRM:
1 .Xoang däc trªn
2 – LiÒm n·o
5 – Th©n thÓ trai (CC)
6 – N·o thÊt bªn (VL)
7 –V¸ch trong suèt
8 – r·nh däc n·o
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Gi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·o
TDM & IRM
1-Xoang däc trªn
2 –LiÒm n·o
5 - CC
6 - VL
8 – R·nh däc n·o
9 – Nh©n ®u«i
10 - §¸m rèi m¹ch m¹c
11 – Thuú ®¶o
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Gi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·o
TDM & IRM
1 - SSS
5 - CC
6 - VL (sõng tr¸n)
9 - §Çu nh©n ®u«i
12 - §åi thÞ
13 – Xoang TM däc d- íi
14 – Bao trong
15 – Nh©n bÌo
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Gi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oTDM & IRM
1 - SSS2 – LiÒm n·o6 - VL (sõng chÈm)8 - FLC
10 - §¸m rèi m¹ch m¹c v«i hãa
12 - Thalamus13 – Xoang däc d- íi (SSI)14 – Bao trong15 –Nh©n bÌo16 – c¸c r·nh bªn ( Sylvius)17 – N·o thÊt ba (V3)18 – tuyÕn tïng v«i ho¸19 – Xoang tr¸n20 – Thuú tr¸n21 – Thuú ®Ønh22 –Thuú chÈm
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Gi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·o
TDM & IRM
22 – Thuú chÈm
23 – Thuú th¸i d- ¬ng
24 – Hèc m¾t
25 - §M n·o gi÷a
26 – Cuèng n·o
27 – èng n·o gi÷a
28 –C¸c sîi thÞ gi¸c
30 – cñ n·o sinh t- trªn
31 – Thuú nhéng
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Gi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·o
TDM & IRM
22 –Thuú chÈm
23 – thuú th¸i d- ¬ng
29 – CÇu n·o
31 - Vermis
32 – TK thÞ gi¸c
34 –M¾t
35 – Cñ n·o sinh t- d- íi
36 – Th©n nÒn
37 –Chç ®Ì vµo cña TK sinh ba
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Gi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oTDM & IRM
29 – Cçu n·o
31 - Vermis
38 – Hèc mòi
39 –Xoang b- ím
40 – x- ¬ng ®¸
41 – Cuèng tiÓu n·o
42 – NT IV
43 – Héi l- u c¸c xoang
44 – Xoang sigma
56 –b¸n cÇu tiÓu n·o
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Gi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·o
TDM & IRM
31 - Vermis
38 –Hèc mòi
39 – Xoang b- ím
40 – X- ¬ng ®¸
44 –Xoang sigma
45 – Xoang hµm
46 – Hµnh n·o (bulbe)
47 - vßm
48 – H¹nh nh©n tiÓu n·o (amygdale)
56 – B¸n cÇu tiÓu n·o
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Gi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·oGi¶i phÉu ®iÖn quang n·o
TDM :
38 –Hèc mòi
45 – Xoang hµm
46 – Tuû sèng kÐo dµi
47 - Cavum
48 – amygdale TN
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T- íi m¸u n·oT- íi m¸u n·oT- íi m¸u n·oT- íi m¸u n·o
Vïng t- íi m¸uVïng t- íi m¸u §§M n·o tr- ícM n·o tr- íc
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