The meningohypophyseal trunk is the first branch of the internal carotid artery in the cavernous sinus, arising from the posterior genu of the ICA and dividing into three branches: the inferior hypophyseal artery (to the posterior pituitary), the tentorial artery (of Bernasconi-Cassinari, to the tentorium and incisura), and the dorsal meningeal artery (to the dorsal dura of the cavernous sinus and clivus). It supplies the dural walls of the cavernous sinus and adjacent posterior cranial fossa structures.
The meningohypophyseal trunk is the dominant blood supply to cavernous sinus meningiomas and clival meningiomas, and its embolisation is part of pre-operative devascularisation for large meningiomas of the cavernous sinus and petrous regions. The tentorial branch (Bernasconi-Cassinari artery) is a classic angiographic marker of tentorial meningioma. The inferior hypophyseal branch supplies the posterior pituitary neurohypophysis — its sacrifice during cavernous sinus surgery risks diabetes insipidus.
Pre-operative embolisation of the meningohypophyseal trunk reduces intraoperative blood loss during cavernous sinus meningioma resection; the inferior hypophyseal branch must be identified and preserved or the risk of post-operative diabetes insipidus from neurohypophyseal ischaemia is carefully weighed against surgical haemostasis benefit.
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