Accessory Meningeal Arterial Supply to the Posterior Nasal Cavity: Another Reason for Failed Endovascular Treatment of Epistaxis

Abstract

A patient with intractable posterior epistaxis was treated with embolization of the ipsilateral sphenopalatine and facial arteries and contralateral sphenopalatine artery. She continued to bleed despite a seemingly adequate embolization procedure. A second angiogram revealed a significant collateral blood supply to the posterior nasal cavity from the accessory meningeal artery not identified during the first procedure. This was then embolized with no further epistaxis encountered. This case demonstrates yet another collateral arterial pathway that might account for a failed embolization.

Unusual Origin and Relations of the Accessory Meningeal Artery - A Case Report

“…Rarely, the accessory meningeal artery supplies the posterior part of the nasal cavity. This fact has to be kept in mind while treating intractable posterior epistaxis with embolization of the ipsilateral sphenopalatine and facial arteries and contralateral sphenopalatine artery (Duncan & Dos Santos, 2003). Auriculotemporal nerve is a branch of the posterior division of the mandibular nerve.…”

Extracranial Embolization

“…i) Accessory meningeal arteries may also rarely be a source of bleeding in epistaxis and can be embolized. 25 j) A review of embolization compared to internal maxillary ligation suggested that ligation was more effective and, although the complications were more frequent than for embolization, the major complications of embolization (stroke) were more serious. except in cases when an obvious major neurological de fi cit will result.…”

Essential Neurovascular Anatomy

“…The artery also supplies the posterior nasal cavity and can be a source of nasal bleeding. 62 The intracranial contribution is usually small and enters the skull through foramen ovale (most commonly) or the sphenoidal emissary foramen of Vesalius (in 22% of cases). 60 The intracranial rami supply the meninges of variable portions of the middle cranial fossa, portions of the cavernous sinus and the trigeminal nerve and its ganglion.…”