Dangerous Extracranial-Intracranial Anastomoses: What the Interventionalist Must Know

Area of Science:

• Neurology
• Vascular Anatomy
• Interventional Neuroradiology

Background:

• The brain's extracranial and intracranial circulations possess significant interconnectedness, enabling adaptive plasticity in vasoocclusive diseases.
• These natural connections, while beneficial, pose risks during extracranial vessel embolization, potentially leading to stroke or cranial nerve palsy.
• Safe embolization relies on understanding functional anatomy and adhering to established principles.

Purpose of the Study:

• To review the anatomy of extracranial-intracranial anastomoses.
• To outline strategies for preventing inadvertent intracranial embolization.
• To detail the vascular supply of at-risk cranial nerves and mucosal structures during neurointerventional procedures.

Main Methods:

• Anatomical review of extracranial-intracranial anastomoses.
• Discussion of principles for safe embolization.
• Vascular supply analysis for cranial nerves and mucosal structures.

Main Results:

• Detailed anatomical description of key extracranial-intracranial connections.
• Identification of predictable circumstances for flow through these anastomoses.
• Strategies for risk mitigation during embolization procedures.

Conclusions:

• Safe embolization of extracranial vessels is achievable with thorough anatomical knowledge.
• Understanding anastomotic pathways is key to avoiding inadvertent intracranial embolization.
• Awareness of cranial nerve and mucosal vascularization aids in preventing procedural complications.