open access
The petrosal artery and its variations: a comprehensive review and anatomical study with application to skull base surgery and neurointerventional procedures
Affiliations- Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, United States
- Physician Assistant Programme, Wagner College, Staten Island, New York, United States
- Division of Anatomy, Department of Radiology, Weill Cornell Medicine, New York, NY, United States
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurosurgery, Tulane Centre for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada, West Indies
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, United States
- University of Queensland, Brisbane, Australia
open access
Abstract
Background: The petrosal artery supplies several structures at the skull base and is
often the focus of various neurointerventional procedures. Therefore, knowledge
of its anatomy and variations is important to surgeons and interventionalists.
Materials and methods: Twenty latex injected cadaveric heads (40 sides) underwent
microsurgical dissection of the petrosal artery. Documentation of the course
of the artery and its branches were made. Measurements of the petrosal artery’s
length and diameter were performed using microcallipers.
Results: A petrosal artery was identified on all sides. The mean length and diameter
of the artery within the middle cranial fossa was 2.4 cm and 0.38 mm, respectively.
Branches included the following: dural, ganglionic, V3 branches, branches
extending through the foramen ovale, branches directly to the greater petrosal and
lesser petrosal nerves, branches to the floor of the hiatus of the greater and lesser
petrosal nerves, branch to the arcuate eminence, and superior tympanic artery. No
statistically significant differences were noted between male and female specimens,
but right-sided petrosal arteries were in general, larger in diameter than left sides.
Conclusions: A thorough anatomical knowledge of the petrosal artery and to its
relationship to the facial nerve and other neurovascular structures is necessary to
facilitate effective endovascular treatment and to preclude facial nerve complications.
Abstract
Background: The petrosal artery supplies several structures at the skull base and is
often the focus of various neurointerventional procedures. Therefore, knowledge
of its anatomy and variations is important to surgeons and interventionalists.
Materials and methods: Twenty latex injected cadaveric heads (40 sides) underwent
microsurgical dissection of the petrosal artery. Documentation of the course
of the artery and its branches were made. Measurements of the petrosal artery’s
length and diameter were performed using microcallipers.
Results: A petrosal artery was identified on all sides. The mean length and diameter
of the artery within the middle cranial fossa was 2.4 cm and 0.38 mm, respectively.
Branches included the following: dural, ganglionic, V3 branches, branches
extending through the foramen ovale, branches directly to the greater petrosal and
lesser petrosal nerves, branches to the floor of the hiatus of the greater and lesser
petrosal nerves, branch to the arcuate eminence, and superior tympanic artery. No
statistically significant differences were noted between male and female specimens,
but right-sided petrosal arteries were in general, larger in diameter than left sides.
Conclusions: A thorough anatomical knowledge of the petrosal artery and to its
relationship to the facial nerve and other neurovascular structures is necessary to
facilitate effective endovascular treatment and to preclude facial nerve complications.
Keywords
skull base, anatomy, surgery, neurosurgery, middle meningeal artery, meningioma
About this articleTitle
The petrosal artery and its variations: a comprehensive review and anatomical study with application to skull base surgery and neurointerventional procedures
Journal
Issue
Article type
Original article
Pages
568-579
Published online
2022-06-10
Page views
1260
Article views/downloads
984
DOI
Pubmed
Bibliographic record
Folia Morphol 2023;82(3):568-579.
Keywords
skull base
anatomy
surgery
neurosurgery
middle meningeal artery
meningioma
Authors
A. Yu
G. Dupont
J. Nerva
S. N. Anadkat
A. V. D’Antoni
A. Wang
J. Iwanaga
A. S. Dumont
R. S. Tubbs
References (33)- Baltsavias G, Kumar R, Valavanis A. The pharyngo-tympano-stapedial variant of the middle meningeal artery. A case report. Interv Neuroradiol. 2012; 18(3): 255–258.
- Bhatia KD, Kortman H, Lee H, et al. Facial nerve arterial arcade supply in dural arteriovenous fistulas: anatomy and treatment strategies. AJNR Am J Neuroradiol. 2020; 41(4): 687–692.
- Bonasia S, Smajda S, Ciccio G, et al. Middle meningeal artery: anatomy and variations. AJNR Am J Neuroradiol. 2020; 41(10): 1777–1785.
- Byrne JV. Tutorials in endovascular neurosurgery and interventional neuroradiology. 1st ed. Springer, Berlin Heidelberg 2012.
- Dilenge D, Ascherl GF. Variations of the ophthalmic and middle meningeal arteries: relation to the embryonic stapedial artery. Am J Neuroradiol. 1980; 1(1): 45–54.
- El-Khouly H, Fernandez-Miranda J, Rhoton AL. Blood supply of the facial nerve in the middle fossa: the petrosal artery. Neurosurgery. 2008; 62(5 Suppl 2): ONS297–ONS303.
- Gatto LA, Saurin F, Koppe GL, et al. Facial palsy after embolization of dural arteriovenous fistula: a case report and literature review. Surg Neurol Int. 2017; 8: 270.
- Geibprasert S, Pongpech S, Armstrong D, et al. Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know. AJNR Am J Neuroradiol. 2009; 30(8): 1459–1468.
- Gray H. Anatomy, Descriptive and Applied, by Henry Gray. 18th ed., Thoroughly Rev. and Re-Edited with Additions, by Edward Anthony Spitzka ... Illustrated with 1208 Engravings. Lea & Febiger, Philadelphia and New York 1910.
- Harrigan MR, Deveikis JP. Handbook of cerebrovascular disease and neurointerventional technique. 3rd ed. Springer International Publishing 2018.
- Iwanaga J, Singh V, Ohtsuka A, et al. Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors. Clin Anat. 2021; 34(1): 2–4.
- Jittapiromsak P, Sabuncuoglu H, Deshmukh P, et al. Greater superficial petrosal nerve dissection: back to front or front to back? Neurosurgery. 2009; 64(5 Suppl 2): 253–258.
- Krmpotic-Nemanic J, Draf W, Helms J. Surgical anatomy of head and neck. 1st ed. Springer-Verlag, Berlin Heidelberg 1988.
- Lasjaunias P, Berenstein A. Surgical Neuroangiography: 1. Functional Anatomy of Craniofacial Arteries. 1st ed. Springer, Berlin Heidelberg 1987.
- Lasjaunias P, Berenstein A, Brugge KG. Clinical vascular anatomy and variations. 2nd ed. Springer, Berlin Heidelberg 2001.
- Lim EH, Mohd Khairi DM. Facial nerve palsy after transarterial embolization of dural arteriovenous fistula. Egypt J Ear Nose Throat Allied Sci. 2017; 18(2): 159–161.
- Martins C, Yasuda A, Campero A, et al. Microsurgical anatomy of the dural arteries. Operative Neurosurgery. 2005; 56(suppl_4): ONS-211–ONS-251.
- McLennan JE, Rosenbaum AE, Haughton VM. Internal carotid origins of the middle meningeal artery. Neuroradiology. 1974; 7(5): 265–275.
- Menshawi K, Mohr JP, Gutierrez J. A functional perspective on the embryology and anatomy of the cerebral blood supply. J Stroke. 2015; 17(2): 144–158.
- Moonis G, Mani K, O'Malley J, et al. A venous cause for facial canal enlargement: multidetector row CT findings and histopathologic correlation. AJNR Am J Neuroradiol. 2011; 32(5): E83–E84.
- Odat H, Alawneh K, Al-Qudah M. Facial nerve paralysis after onyx embolization of a jugular paraganglioma: a case report with a long-term follow up. J Clin Med. 2018; 7(3): 48.
- Padget DH. The circle of Willis: its embryology and anatomy. Comstock Publishing, New York 1945.
- Paget DH. The development of the cranial arteries in the human embryo. Contrib Embryol. 1948; 32: 205–262.
- Paullus WS, Pait TG, Rhoton AI. Microsurgical exposure of the petrous portion of the carotid artery. J Neurosurg. 1977; 47(5): 713–726.
- Pecket P, Schattner A. Concurrent Bell's palsy and diabetes mellitus: a diabetic mononeuropathy? J Neurol Neurosurg Psychiatry. 1982; 45(7): 652–655.
- Sant’Anna MAF, Luciano LL, Chaves PHS, et al. Anatomy of the middle meningeal artery. Arquivos Brasileiros de Neurocirurgia. 2021; 40(4): e339–e348.
- Schuknecht HF. Pathology of the ear. 2nd ed. Lea & Febiger, Philadelphia 1993.
- Shao YX, Xie X, Liang HS, et al. Microsurgical anatomy of the greater superficial petrosal nerve. World Neurosurg. 2012; 77(1): 172–182.
- Shapiro M, Walker M, Carroll KT, et al. Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization. J Neurointerv Surg. 2021; 13(5): 471–477.
- Shibao S, Borghei-Razavi H, Yoshida K. Intraspinosum middle meningeal artery ligation: a simple technique to control bleeding in the middle fossa during the anterior transpetrosal approach. Oper Neurosurg (Hagerstown). 2017; 13(2): 163–172.
- Shotar E, Premat K, Lenck S, et al. Middle meningeal artery embolization for chronic subdural hematoma. Case Med Res. 2019; 32(1): 57–67.
- Stranding S. Gray’s anatomy: the anatomical basis of clinical practice. 41st ed. Elsevier, New York 2016.
- Tanoue S, Kiyosue H, Mori H, et al. Maxillary artery: functional and imaging anatomy for safe and effective transcatheter treatment. Radiographics. 2013; 33(7): e209–e224.
