Download Arterial anatomy

Arterial anatomy in the cavernous sinus region (Illustration of small dural arteries
arising from ICA and ECA, so called “dangerous anastomoses“ in the cavernous sinus
region, lateral view.)
The small branches of the ICA and ECA connecting both territories in the cavernous sinus
region are also referred to as “dangerous anastomoses“. Because of their small caliber
these branches are often not visualized in arteriograms, unless they are enlarged due to
increased flow caused by AV-shunting lesions, arterial occlusions or tumors. Untoward
migration of embolic material into the brain territories during transarterial embolization of
ECA branches is possible. However, it is not the vessel per se that is “dangerous“ but lack
of knowledge or non-observance of the particular anatomy in the region by the operator.
In case of developing arteriovenous shunts within or adjacent to the cavernous sinus these
branches usually enlarge and become supplying feeders.
Furthermore, even in case of successful selective positioning of a microcatheter in one of
the ILT or MHT branches reflux of embolic material such as particles or glue may easily
occur, leading to neurological complications.
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1 Internal carotid artery (ICA, C5)
2 Internal carotid artery (C4)
3 Ophthalmic artery (OA)
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4 Meningohypophyseal trunk (MHT)
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Inferior hypophyseal artery
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Lateral clival artery
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Medial clival artery
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Basal tentorial artery
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Marginal tentorial artery
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10 Inferolateral trunk (ILT )
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Superior ramus
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Anteromedial ramus
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Anterolateral ramus
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Posterolateral ramus
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Posteromedial ramus
16 Capsular arteries
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External carotid artery (ECA)
Ascendending pharyngeal (APA)
Superficial temporal artery
Internal maxillary artery (IMA)
Middle meningeal artery (MMA)
Accessory meningeal artery (AMA)
Sphenopalatine artery
Artery of the foramen rotundum (AFR)
Recurrent artery of the foramen
lacerum
26 Pterygopalatine artery (Vidian artery)
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