Clinical and anatomical perspective of the meningohypophyseal trunk: a comprehensive review

脑膜垂体干的临床和解剖学视角:一项综合综述

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Abstract

PURPOSE: Meningohypophyseal trunk (MHT) is a small branch of cavernous part of the internal carotid artery (ICA) which trifurcates into tentorial, inferior hypophyseal and dorsal meningeal arteries. MHT often provides the feeder artery for skull-base meningiomas. Therefore, this arterial trunk is frequently chosen for preoperative embolization. Due to its clinical importance we summarized information about its anatomical variations and relevant clinical attributes pertaining to embolization procedures as reported in literature. MATERIALS AND METHODS: We performed a systematic review of PubMed and Embase databases according to the PRISMA 2020 guidelines. Studies with anatomical description of the MHT or embolization of this vessel were included. RESULTS: From 150 identified studies, 49 full-texts were analyzed and 25 of them were included in this systematic review. Seventeen of included studies described morphological features of the MHT (origin from the ICA, complete/incomplete type) and 8 studies depicted embolization of the MHT. The most common origin of the MHT was the posterior loop of the cavernous ICA and in majority of cases complete trifurcated type of the MHT was observed. Embolization of the MHT was successful in nearly all of the patients with lower risk of complications when balloon protection was used. CONCLUSIONS: Relevant morphological details about MHT might facilitate neurosurgeons during planning procedures involving cavernous sinus area but there is no significant correlation between anatomy of the MHT and risk of possible complications. Choice of method and embolic agent during embolization may be approached with customized perspective of the operator. This may be associated with reduced risk of complications and better outcome from clinical viewpoint.

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