The accessory meningeal artery is a branch of the maxillary artery that passes through the foramen ovale (or a separate foramen spinosum accessory) to supply the trigeminal ganglion, the dura of the middle cranial fossa, and the cavernous sinus. It is a variant in 30-50% of individuals, and when present it must be distinguished from the middle meningeal artery on angiography and respected during foramen ovale approaches for percutaneous trigeminal procedures.
The accessory meningeal artery is encountered in percutaneous trigeminal rhizotomy and Gamma Knife surgery planning for trigeminal neuralgia, where the foramen ovale approach to Meckel cave may encounter this vessel. It may be the dominant supply to the trigeminal ganglion and its inadvertent injury during foramen ovale cannulation can cause Gasserian ganglion haemorrhage. In endovascular treatment of dural arteriovenous fistulae, the accessory meningeal artery may be a fistula pedicle accessible through the foramen ovale transvenous route.
The accessory meningeal artery entering the foramen ovale alongside the mandibular nerve is encountered during percutaneous trigeminal rhizotomy needle placement, and its injury within Meckel cave produces haematoma causing sudden trigeminal deficit; careful needle advancement under fluoroscopic guidance with lateral check after cerebrospinal fluid return minimises this risk.
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