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Intracavernous branches of the internal carotid artery (ICA)

Comprehensive review of their variations

Collatérales intra-caverneuses de la carotide interne:

Synthèse de leurs variations

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Summary

Since we started to work in the lateral sellar region (in 1973), a large volume of angiographic material has provided us with exceptional variations that added to the anatomic facts obtained from our dissections. At present, these anatomic facts remain, but the way we look at them and the way we use them for endovascular treatments, has created a need for a different type of approach and understanding.

In this report, we present a flexible anatomical view of the intracavernous branches of the internal carotid artery and a scheme to understand and predict the anatomical variations of these collaterals. Four embryonic vessels play an important role in the variations of the arterial supply to the lateral cavernous region: the dorsal ophthalmic artery, the stapedial artery, the trigeminal artery and the primitive maxillary artery. In general each of them partially regresses leaving behind a remnant. However there is a spectrum from their persistence to incomplete regression, resulting in variations of the supply to their distal territories. The term “meningohypophyseal” should be abandoned because it is misleading and improperly used.

Complete agenesis is known for a long time; in case of segmental agenesis of the ICA each of the embryonic vessels presented above may represent an alternate route to bypass the agenesis. The ICA is not a direct feeding artery but a succession of independant segments which can be the site of various anomalies. An embryonic transdural circle can be individualized; it is constituted by the trigeminal arteries posteriorly, the ICA siphon anteriorly, the transsellar anastomosis and internal maxillary artery connections. Although regressions usually occur in this embryonic transdural circle, its derivatives congenital and acquired arterial pathologies. It also constitutes the key system in determining the arterial variations of the perisellar region.

Résumé

Depuis que nous avons commencé notre travail, sur la région latéro-sellaire (en 1973), une grande quantité d'angiographies sélectives de variations vasculaires est venue compléter le matériel anatomique que nous avions obtenu à partir des dissections. Aujourd'hui les faits anatomiques observés restent, mais la faÇon dont nous les regardons et la manière dont nous les utilisons pour nos traitements endovasculaires nécessitent une vision et une présentation différente de ces variétés.

Dans cet article, nous proposons une vision anatomique « flexible » des branches intra-caverneuses de la carotide interne à partir d'un schéma générique permettant de comprendre et de prédire les variations de ces collatérales. 4 vaisseaux embryonnaires jouent un rÔle clé dans le déterminisme des variations artérielles de cette région: l'artère ophtalmique dorsale, l'artère stapédienne, l'artère trijéminée et l'artère maxillaire primitive. En général, chacune d'entre elles régresse partiellement, laissant derrière elle un reliquat artériel. En fait, il existe toute une gamme possible, entre la persistance du vaisseau embryonnaire et le reliquat; chacun de ces intermédiaires, crée une variation dans le territoire de vascularisation de ces artères. Ainsi le terme de tronc méningo-hypophysaire devrait Être abandonné car il est source de confusion et utilisé la plupart du temps de faÇon anatomiquement impropre.

De mÊme, l'agénésie complète de la carotide interne est connue depuis longtemps; mais en cas d'agénésie incomplète de la carotide interne chacun des vaisseaux embryonnaires présentés ci-dessus constitue une voie de suppléance, court-circuitant le segment agénatique. La carotide interne ne doit pas Être considérée comme une artère nourricière proprement dite mais comme une succession de segments indépendants pouvant Être le siège d'anomalies multiples mais spécifiques. Enfin, on peut donc décrire, un cercle embryonnaire trans-dural constitué par les artères trijéminées en arrière, les siphons carotidiens en avant, l'anastomose trans-sellaire sur la ligne médiane et les anastomoses maxillaires internes en dehors. Bien que chacun des éléments de ce cercle embryonnaire régresse au cours du développement, ces reliquats constituent en pratique des voies accessoires fournissant la circulation collatérale efficace aussi bien dans les anomalies congénitales qu'acquises du tronc artériel carotidien interne. Ce cercle artériel embryonnaire constitue le système clé du déterminisme des variétés artérielles de la région péri-sellaire, ses variétés sont indépendantes de celles du cercle de Willis.

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Willinsky, R., Lasjaunias, P. & Berenstein, A. Intracavernous branches of the internal carotid artery (ICA). Surg Radiol Anat 9, 201–215 (1987). https://doi.org/10.1007/BF02109631

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