Article Figures & Data
Figures
- Fig 1.
MPR images of rotational angiography in patients with left cavernous sinus dural arteriovenous fistulas. The coronal plane at the level of the inferior orbital fissure (IOF) shows the infraorbital artery (IOA) running through the inferior orbital fissure, through which the pterygopalatine fossa communicates anteriorly with the orbita. The third segment of the maxillary artery (Max A) is located in the pterygopalatine fossa. The coronal plane at the level of the medial part of the PPF shows the pterygopalatine fossa communicating superiorly with the orbital apex (arrowheads) at the SOF. Note a small arterial branch (artery of the SOF) running from the PPF to the SOF through this communication pathway. The PPF communicates medially with the nasal cavity via the sphenopalatine canal containing the sphenopalatine artery (SPA). The PPF communicates posteriorly with the middle cranial fossa via the foramen rotundum (FR), which contains the artery of the foramen rotundum (AFR). The superior orbital fissure continues to the cavernous sinus (CS). MMA indicates middle meningeal artery.
- Fig 2.
Schematic drawing of the course of the artery of the SOF from the third segment of the maxillary artery (MA). The artery of the SOF (ASOF) runs upward to reach the orbital apex and turns posteriorly to enter the cavernous sinus through the SOF. It has potential anastomosis with the anteromedial branch of the ILT and the ophthalmic artery (OPA). The artery of the foramen rotundum and the artery of the pterygoid canal (APC) run more posteriorly to enter the middle cranial fossa through the foramen rotundum and the foramen lacerum through the pterygoid canal, respectively. The infraorbital artery runs anteriorly to enter the orbital fossa through the inferior orbital fissure.
- Fig 3.
Case of left cavernous sinus dural arteriovenous fistulas supplied by the artery of superior orbital fissure. A, The lateral view of the right external carotid angiography shows cavernous sinus dural arteriovenous fistulas fed by multiple feeding arteries, including the artery of the foramen rotundum (arrows) and the artery of the SOF (arrowheads). The artery of the foramen rotundum (arrows) originates posterosuperiorly from the pterygopalatine segment of the maxillary artery and runs posterosuperiorly to the cavernous sinus. The artery of the SOF arises more superiorly from the maxillary artery and runs upward. B, Axial reformatted images of the rotational angiography of the right external carotid artery. The artery of the SOF (arrow) originates at the terminal portion of the maxillary artery just before the sphenopalatine artery. The artery of the foramen rotundum (AFR) originates at the more proximal portion of the pterygopalatine segment of the maxillary artery. The artery of the foramen rotundum runs posteriorly to enter the middle cranial fossa through the foramen rotundum. The artery of the SOF runs upward in the posteromedial portion of the pterygopalatine fossa, and then it runs posteriorly to enter the cavernous sinus through the SOF. The intracranial part of the arterial opacification represents its anastomosis with the anteromedial branch of the inferolateral trunk. Note that the inferior orbital artery (IOA) runs anteriorly to enter the orbital floor through the inferior orbital fissure. C, Sagittal MPR images show that the artery of the foramen rotundum runs posterosuperiorly in the pterygopalatine fossa and enters the middle cranial fossa through the foramen rotundum. The artery of the SOF (arrows) originates independently from the artery of the foramen rotundum and runs upward in the small canal to reach the orbital apex and then turns posteriorly to enter the cavernous sinus through the SOF by anastomosis with the anteromedial branch of the inferolateral trunk.
- Fig 4.
Case of parasellar meningioma supplied by the artery of the SOF. A, Lateral view of the right external carotid angiography in a patient with a sphenoid ridge (parasellar) meningioma showing a remarkable stain supplied by multiple feeding arteries from the maxillary arteries. Arrows indicate the artery of the foramen rotundum, and arrowheads indicate the artery of the SOF. B, Sagittal MPR images of rotational angiography of the right external carotid angiography show that the artery of the SOF (arrows) originates at the distal portion of the maxillary artery. It runs upward into the SOF and feeds the tumor. The artery of the foramen rotundum (AFR) runs posterosuperiorly through the foramen rotundum and enters the middle cranial fossa to feed the tumor. C, Selective angiography with contrast injection at the terminal portion of the maxillary artery clearly shows the artery of the SOF (arrows) supplying the tumor.
- Fig 5.
Case of left internal carotid artery occlusion with collateral from the maxillary artery to the internal carotid artery and the ophthalmic artery via the artery of the SOF. A, Lateral view of the left common carotid angiography in a patient with occlusion of the cervical internal carotid artery shows multiple collaterals from the external carotid artery to the ophthalmic artery and the ILT of the internal carotid artery. Arrows indicate the artery of the foramen rotundum communicating with the ILT. Arrowheads indicate the artery of the SOF communicating with the ILT and ophthalmic artery. B, Sagittal MPR images of rotational angiography of the left common carotid artery show the artery of the foramen rotundum running posterosuperiorly to anastomose with the ILT. The artery of the SOF (arrows) runs upward and connects posteriorly with the ILT and anterosuperiorly with the ophthalmic artery (OPA). Arrowheads indicate the anteromedial branch of the ILT. C, Coronal MPR image of rotational angiography of the left common carotid artery showing that the artery of the SOF (arrows) originates by a common trunk with the artery of the foramen rotundum (AFR). Note an anastomosis between the artery of the SOF and the ophthalmic artery at the orbital apex.
- Fig 6.
Schematic drawing of the anastomotic arteries between the maxillary artery and internal carotid artery in the fetal period (upper figure) and potential anastomosis in an adult (lower figure). The ophthalmic artery anastomoses with the anterior branch of the middle meningeal artery (AB of MMA) and an ophthalmic branch of the maxillary artery (arrow). Several branches arising from the internal carotid artery anastomose with the branches of the maxillary arteries, including the middle meningeal artery (MMA), accessory meningeal artery (AMA), artery of the foramen rotundum (ARF), and the ophthalmic branch of the maxillary artery (arrow) in the fetal period. Anastomotic branches from the internal carotid artery become branches of the ILT. There are several potential anastomoses between the maxillary artery branches and the ILT. The ophthalmic branch of the maxillary artery and its anastomoses in the fetal period becomes the artery of the superior orbital fissure.
Tables
Characteristics of 54 patients
Characteristic Patient Data Gender, n Male 30 Female 24 Age (range [average]), y 23–85 (67.7) Injected arteries, n Right ECA 18 Left ECA 17 Right CCA 14 Left CCA 15 Diseases, n CSDAVF 13 Other DAVF 6 Meningioma 7 Glioma 3 Head or neck tumor 2 ICA stenosis 15 ICA occlusion 3 Other disease 5 Note:—CCA indicates common carotid artery; CSDAVF, cavernous sinus dural arteriovenous fistula; DAVF, dural arteriovenous fistula; ECA indicates external carotid artery.
