Branches of the petrous and cavernous segments of the internal carotid artery

Abstract

Microsurgical approaches to the skull base require a thorough knowledge of the microvasculature of this region. Interestingly, most standard texts of anatomy do not mention the branches of the internal carotid artery as it travels through the temporal bone and cavernous sinus. Although small and with often conflicting descriptions, these arterial branches may be of significance when contributing to the vascular supply of such pathological entities as meningiomas and vascular malformations. Furthermore, multiple anastomoses exist between these branches and branches of the external carotid artery, thus providing a potentially important collateral circulation between these two systems and thus retrograde flow needed to maintain the patency of the distal internal carotid artery (ICA) when this vessel is obstructed proximally. We review the literature regarding these branches of the internal carotid artery and their clinical significance.

Dangerous Extracranial–Intracranial Anastomoses and Supply to the Cranial Nerves: Vessels the Neurointerventionalist Needs to Know

“…The corresponding branches of the ICA are the mandibular artery (remnant of the dorsal part of the first aortic arch) and the caroticotympanic artery (remnant of the embryologic hyoid artery) for the petrous territory, the meningohypophyseal trunk (remnant of the embryologic primitive maxillary artery) and the lateral clival artery for the clival territory, and the ILT (remnant of the embryologic dorsal ophthalmic artery) for the cavernous region. 7,18,19 The major anastomotic routes to the ILT are summarized in Table 3.…”

“…Within the middle ear, the inferior tympanic artery also anastomoses with the superior tympanic artery, which arises from the petrous branch of the MMA, the anterior tympanic artery from the proximal IMA, the stylomastoid artery from the posterior auricular-occipital artery, and the mandibular branch of the ICA. 7,19 Typically these anastomoses are not visualized on the cerebral angiograms but may open up during embolization. In some rare cases, agenesis of the cervical ICA and persistence of the embryologic hyostapedial artery will result in the so-called "aberrant ICA," in which the ICA enters the skull base through …”

“…18,19,24 After exiting the foramen spinosum, the MMA gives off cavernous branches that anastomose with the superior or tentorial branch of the ILT. The orbital branches of the MMA, besides their connection to the ophthalmic artery, also anastomose with the anteromedial branch of the ILT within the superior orbital fissure.…”

Basic Vascular Neuroanatomy of the Brain and Spine: What the General Interventional Radiologist Needs to Know

“…There are several small but clinically significant branches of the ICA that are routinely identified on angiography including the vidian artery which arises from the horizontal petrous segment, and the inferolateral and meningohypophyseal trunks that arise from the cavernous carotid. 6 These branches were mentioned previously as important anastomotic collateral pathways from the extracranial to the intracranial circulation.…”

Persistent Fetal Intracranial Arteries

“…This branch arises from the petrous portion of the internal carotid artery and enters the tympanic cavity through a foramen in the wall of the vertical portion of the carotid canal; angiographically, it cannot be seen due to the density of the petrous portion of the temporal bone (Tubbs et al 2007). The incidence of the otic artery has not been reported in the literature because it is very rare and this area is difficult to image.…”