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

Abstract

SUMMARY:Transarterial embolization in the external carotid artery (ECA) territory has a major role in the endovascular management of epistaxis, skull base tumors, and dural arteriovenous fistulas. Knowledge of the potential anastomotic routes, identification of the cranial nerve supply from the ECA, and the proper choice of embolic material are crucial to help the interventionalist avoid neurologic complications during the procedure. Three regions along the skull base constitute potential anastomotic routes between the extracranial and intracranial arteries: the orbital, the petrocavernous, and the upper cervical regions. Branches of the internal maxillary artery have anastomoses with the ophthalmic artery and petrocavernous internal carotid artery (ICA), whereas the branches of the ascending pharyngeal artery are connected to the petrocavernous ICA. Branches of both the ascending pharyngeal artery and the occipital artery have anastomoses with the vertebral artery. To avoid cranial nerve palsy, one must have knowledge of the supply to the lower cranial nerves: The petrous branch of the middle meningeal artery and the stylomastoid branch of the posterior auricular artery form the facial arcade as the major supply to the facial nerve, and the neuromeningeal trunk of the ascending pharyngeal artery supplies the lower cranial nerves (CN IXϪXII).

Effectiveness of superselective intra-arterial chemoradiotherapy targeting retropharyngeal lymph node metastasis

“…The ascending pharyngeal artery is also known to supply the lower cranial nerves and this procedure has an associated risk of lower cranial neuropathy [22], although none of the patients suffered severe complications, including lower cranial neuropathy, in the present study. It is known that the ascending pharyngeal artery diverges into two branches, the pharyngeal trunk and the meningeal trunk.…”

“…The ascending pharyngeal artery is usually the smallest of the arteries that diverge from the external carotid artery and is generally considered to feed the RPLNs [21]. Low-dose cisplatin infusion is thought to be sufficient for the eradication of RPLNs because the ascending pharyngeal artery is narrow and RPLN metastasis is usually quite limited in comparison with lymph node metastases in level I-V.The ascending pharyngeal artery is also known to supply the lower cranial nerves and this procedure has an associated risk of lower cranial neuropathy [22], although none of the patients suffered severe complications, including lower cranial neuropathy, in the present study. It is known that the ascending pharyngeal artery diverges into two branches, the pharyngeal trunk and the meningeal trunk.…”

Paravertebral Arteriovenous Fistula Treated by Endovascular Coil Embolization

“…13) Since our case was a high flow AVF fed by a single vessel and selective catheterization into the enlarged feeder was possible, transarterial embolization was planned. Moreover, we did not use the liquid agents such as n-butylcyanoacrylate to prevent the risks of migration into the intracranial circulation via aberrant anastomoses 4) and unintentional occlusion of the drainage veins. Several technical adjuncts including proximal temporary balloon occlusion for flow control are important for successful embolization.…”

Percutaneous transcatheter embolization with n-butyl cyanoacrylate of hepatic hemorrhagic lesions in urgent situations

“…Its polymerization characteristics, dilution with Lipiodol, velocity of delivery, reflux control, and anatomical familiarity are important aspects linked to its use, and the clinician must know these well to perform safe, successful procedures. Interventional radiologists must be attentive to some physiological anastomoses, called dangerous anastomoses, during the use of NBCA in specific locations, such as external carotid arteryophthalmic artery-internal carotid artery in the treatment of epistaxis (34) and bronchial artery-anterior spinal artery in the treatment of hemoptysis (35), due to the possibility of neurological complications.…”