The ascending pharyngeal artery and its relevance for neurosurgical and endovascular procedures.
OBJECTIVE
The ascending pharyngeal artery (APA), a branch of the external carotid artery (ECA), supplies the lower cranial nerves, superior cervical ganglion, and nasopharyngeal structures. The APA can also supply blood to various intracranial lesions. We studied the anatomy of the APA in the context of its neurosurgical and endovascular relevance.


METHODS
The cervical origin, branching pattern, and course of the APA were studied in 20 human cadaveric craniocervical sides. The diameter of the APA, the extension of its main trunk, and the distance of its origin from the common carotid artery bifurcation were measured. The relationships between the APA and surrounding structures were also observed.


RESULTS
In 80% of the specimens, the APA originated from the ECA. It originated from its medial wall in 56% and from the posterior wall in 44%. The APA originated from the internal carotid artery, common carotid artery bifurcation, occipital artery, and a trunk common to the lingual and facial arteries in 5% each. The APA was usually the third branch of the ECA (40%). The mean distance from the origin of the APA to the common carotid artery bifurcation was 15.3 mm (range, 0-32; standard deviation, +/- 8.3 mm). The APA was frequently the second smallest branch of the ECA (caliber, 1.54 mm; range, 1.1-2.1; standard deviation, +/- 0.25 mm).


CONCLUSIONS
The APA is an important channel for supplying neural structures of the posterior fossa. Knowledge of its anatomy, variants, and anastomotic channels is essential in the treatment of lesions supplied by its branches and to avoid complications related to its inadvertent injury.
Cavalcanti
Daniel D
DD
Division of Neurological Surgery, Neurosurgery Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Reis
Cassius Vinicius C
CV
Hanel
Ricardo
R
Safavi-Abbasi
Sam
S
Deshmukh
Pushpa
P
Spetzler
Robert F
RF
Preul
Mark C
MC
D000328:Adult; D001165:Arteriovenous Malformations / Q000473:pathology / Q000601:surgery; D002342:Carotid Artery, External / Q000033:anatomy & histology* / Q000502:physiology; D003388:Cranial Fossa, Posterior / Q000098:blood supply*; D003391:Cranial Nerves / Q000098:blood supply*; D004210:Dissection / Q000379:methods; D004388:Dura Mater / Q000098:blood supply*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000098:blood supply / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000098:blood supply; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010614:Pharynx / Q000098:blood supply*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control