Super-Selective Arteriography of the External Carotid Artery

562 Pages·1978·45.396 MB·English

by  René Djindjian, Jean-Jacques Merland (auth.)

R. Djindjian 1.-1. Merland
Super-Selective
Arteriography of the
External Carotid
Artery
With Collaboration of J. THERON
Translated by 1. F. MOSELEY
Preface by R. HOUDART
With 1068 Figures and 5 Plates, Some in Colour
Springer-Verlag
Berlin Heidelberg New York 1978
RENE DJINDJIANt
Professeur de Neuroradiologie it la Faculte de Medecine de Paris
JEAN-JACQUES MERLAND
Chef de Clinique-Assistant it la Faculte de Medecine de Paris
H6pital Lariboisiere, Service de Neurochirurgie, Departement de Neuroradiologie
2, Rue A. Pare, F-75010 Paris (France)
JACQUES THERON
Professeur Agrege de Radiologie, Chef du Service de Radiologie et Neuroradiologie
F-14000 Caen (France)
Dr. IVAN F. MOSELEY
Lysholm Radiological Department, National Hospital for Nervous Diseases
Queen Square, London WC 1N 3BG (Great Britain)
ISBN-13: 978-3-642-66598-1 e-ISBN-13: 978-3-642-66596-7
DOT: 10.1007/978-3-642-66596-7
Library of Congress Cataloging in Publication Data. Djindjian, Rene. Super-selective arteriography of the external
carotid artery, Bibliography: p. Includes index.!. Carotid artery - Radiography. 2. Head - Blood - Vessels
Radiography. I. Merland, Jean-Jacques, 1942, joint author. II. Theron, J., joint author. III. Title. RC936.D56
616.1'3'075777-2949.
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Preface
It was a great honour and a mark of our friendship that RENE DJINDJIAN asked me to
present this new work from the Lariboisiere neuroradiological school.
Professor DJINDJIAN died on 11th October.
Introducing this book now, I feel that I am dealing with a fatherless child, where
feelings of admiration and pleasure are mixed with the sadness of the loss and the
bitterness of an unfinished task.
This work on the superselective angiography of the branches of the external carotid
artery is a direct continuation of the previous studies of Professor DJINDJIAN, whose
name will continue to be closely associated with the development and progress of
arteriography in recent years, particularly with arteriography of the spinal cord. It
was realised together with his pupil, JEAN-JACQUES MERLAND, whose remarkable
thesis for the Doctorat en Medecine a few years ago also dealt with this subject, and
with the collaboration of JACQUES THERON, also for many years a pupil of RENE
DJINDJIAN, and is translated here by his friend I.F. MOSELEY.
In both the external carotid artery and the spinal arteries, selective injection of the
branches is of equal interest, and is equally advantageous: it allows precise definition
of the normal vascular tree, better than an anatomical section in its actual size,
and a picture whose quality fills one with admiration; it demonstrates anomalies
or other changes of a size too small to be detectable by other methods; and in some
cases, it offers an original therapeutic approach, a point which is of extreme interest
in the glimpse it gives of certain possibilities.
Embolisation already occupies an important place in this book, and in the future
we shall be able to define not only its value, but its indications and its limitations;
above all, however, we may expect from this apparently simple technique of entering
into the finest arterial branches the development of a totally new therapeutic
approach, with the possibility not only of temporary or permanent occlusion of a
predetermined vascular territory but also a method of direct introduction of active
substances and even of true intravascular surgery.
For these reasons, we hope that a similar work on the superselective arteriography
of the internal carotid artery will follow, for we are certain that this was RENE
DJINDJIAN'S next goal. His work will undoubtedly be continued by his pupils, JEAN
JACQUES MERLAND in Lariboisiere and JACQUES THERON in Caen.
RAYMOND HOUDART
Acknowledgements
We should like to thank the following physicians (neurologists, neurosurgeons,
vascular surgeons, ophthalmologists, otorhinolaryngologists, dermatologists, sto
matologists, radiologists, neuroradiologists and plastic surgeons) who helped us to
compile this book by referring their patients:
Dr. Andrieu (Rouen) Prof. Lhermitte (Paris)
Prof. Alison (Paris) Prof. Lendrodt (Hamburg)
Dr. Avril (Paris) Prof. Loiseau (Bordeaux)
Prof. Baldy-Moulinier (Montpellier) Dr. Marchand (Paris)
Dr. Bard (Paris) Prof. Marteau (Paris)
Dr. Ie Besnerais (Paris) Mlle. Ie Dr. Masselin (Paris)
Prof. Bloch-Michel (Paris) Prof. May (Paris)
Prof. Bonduelle (paris) Dr. Millard (Paris)
Prof. Bories (Paris) Dr. Mitard (Nantes)
Prof. Boudin (Paris) Dr. Morice (Reims)
Dr. Cabanis (Paris) Dr. Mouly (Paris)
Prof. Cachin (Paris) Prof. Natali (Paris)
Prof. Cambier (Paris) Prof. Narcy (Paris)
Prof. Castaigne (Paris) Prof. Nick (Paris)
Prof. Charbonnel (Nantes) Prof. Passouant (Montpellier)
Mme. Ie Dr. Clay (Paris) Prof. Pialoux (Paris)
Prof. Cophignon (Paris) Prof. Pinel (Paris)
Prof. Cormier (Paris) Prof. Philippon (Paris)
Prof. Debain (Paris) Prof. Poncet (Paris)
Prof. Degos (Paris) Dr. Raverdy (Paris)
Prof. Dufourmentel (Paris) Prof. Rey (Paris)
Prof. Ecoiffier (Paris) Dr. Rougerie (Paris)
Prof. Fleury (Paris) Prof. Ryckewaert (Paris)
Prof. Fohanno (Paris) Dr. Saint-Macary (Paris)
Prof. Galibert (Amiens) Dr. Sauvage (paris)
Prof. Gauthier (Paris) Dr. Senechal (Paris)
Mme. Ie Dr. Godde Joly (Paris) Prof. de Seze (Paris)
Dr. Graveleau (Paris) Dr. Soubavrand (Paris)
Prof. Guillard (Paris) Dr. Tessier (Paris)
Prof. Guyot (Reims) Dr. Thurel (Paris)
Prof. Hautefeuille (Paris) Dr. Tricot (Paris)
Prof. Hurth (Paris) Prof. Vaillant (Paris)
Dr. Kieffer (Paris) Dr. Ve sse (Paris)
Prof. Krayenbiihl (Zurich) Mme. Ie Dr. Vignaud (Paris)
Dr. Laccourreye (Paris) Dr. Vigneul (Paris)
Dr. Lallement (Paris) Prof. Yasargil (Zurich)
Prof. Laplane (Paris)
We should like to thank Prof. Houdart, Mme. Kind and Mme. Arrayet and their
colleagues in the Departments of Neurosurgery, Anaesthesia and Intensive Care,
and Neuroradiology respectively of the Lariboisiere Hospital, Paris.
VIII Acknowledgements
We should also like particularly to thank Dr. Ivan F. Moseley of the Lysholm
Radiological Department, National Hospital for Nervous Diseases, London for
carrying out the English translation.
We should also like to thank particularly Prof. Bories of the Salpetriere Hospital,
Paris, who allowed us to examine a number of cases in his department and to
integrate them into this work.
RENE DJINDJIAN
JEAN-JACQUES MERLAND
JACQUES THERON
Table of Contents
Chapter 1
Normal Super-Selective Arteriography of the External Carotid Artery
I. Technique of Opacification ...................................... .
A. Techniques of Exploration ................................... .
1. Femoral Approach ....................................... .
2. Carotid Approach ........................................ .
3. Temporal Approach ...................................... .
B. Conduct of the Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
C. Injection for Radiography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
II. Lingual Artery ................................................. 5
A. Technique of Investigation and Projections. . . . . . . . . . . . . . . . . . . . . . 5
B. Morphology of the Lingual Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1. Origin of the Lingual Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2. Trunk of the Lingual Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
a) Calibre. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
b) Carotid and Pharyngeal Segments of the Lingual Artery. . . . . . . . 6
c) Lateral Suprahyoid Segment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3. Termination of the Lingual Artery: Deep Lingual Artery........ 6
C. Branches of the Lingual Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1. Branches of the Pharyngeal and Suprahyoid Segments. . . . . . . . . . 7
2. The Sublingual Artery ..................................... 7
3. Branches of the Termination of the Lingual Artery. . . . . . . . . . . . . 8
D. Venous Return. . .. . . . . .. . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 8
E. Anastomoses................................................ 8
III. Facial Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
A. Trunk of the Facial Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1. Lateral View. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
a) Initial Horizontal Submental Segment ..................... 9
b) Superficial Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2. Antero-Posterior Projection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
3. Basal Projection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
4. Variations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
5. Venous Return. .. . . . . .. . .. . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . 10
B. Branches of the First Horizontal Segment of the Facial Artery. . . . . 10
1. Ascending Palatine Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2. Arteries of the Submandibular Gland ........................ 11
a) Main Artery of the Submandibular Gland. . . . . . . . . . . . . . . . . . 11
b) Accessory Arteries of the Submandibular Gland. . . . . . . . . . . . . 11
3. Submental Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
X Table of Contents
C. Branches of the Second, Superficial Segment of the Facial Artery. . . 12
1. Arteries to the Masseter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2. Genial Arteries ........................................... 12
3. Mental Arteries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
4. Labial Arteries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
a) Inferior Labial (Inferior Coronary) Artery. . . . . . . . . . . . . . . . . . 13
b) Superior Labial Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
c) Peri-Oral and Labial Arterial Circle ....................... 13
D. Blood Supply of the Nasal Region and Termination of the
Facial Artery .............................................. 14
IV. Ascending Pharyngeal Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
A. Trunk of the Ascending Pharyngeal Artery. . . . . . . . . . . . . . . . . . . . . . 14
1. Lateral Projection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2. Other Projections ......................................... 15
B. Branches of the Ascending Pharyngeal Artery ................... 15
1. Pharyngeal Branches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2. Branches to the Paravertebral Muscles. . . . . . . . . . . . . . . . . . . . . . . 15
3. Meningeal and Other Intracranial Branches. . . . . . . . . . . . . . . . . . . 16
4. Tympanic Branches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
5. Nervous Branches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
C. Anastomoses ............................................... 17
V. Occipital Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
A. Trunk of the Occipital Artery ................................. 17
1. Lateral Projection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2. Frontal (Towne's) Projection .......... " . . . . . . . . . . . . . . . . . . . . . 18
B. Branches of the Occipital Artery. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 18
1. Branches of the First Ascending Segment. .... . ..... ... ... .... 18
a) Superior Sterno-Mastoid Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . 18
b) Stylomastoid Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2. Branches of the Second, Horizontal Segment. . . . . . . . . . . . . . . . . . 18
3. Branches of the Third Segment of the Occipital Artery.... ...... 19
C. Venous Return.............................................. 19
D. Anastomoses............................................... 19
VI. Posterior Auricular Artery ....................................... 19
VII. Superficial Temporal Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
A. Trunk of the Superficial Temporal Artery. . . . . . . . . . . . . . . . . . . . . . . 20
1. Lateral Projection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2. Antero-Posterior Projection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
B. Branches of the Superficial Temporal Artery .................... 20
1. Parotid Gland Branches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2. Transverse Facial Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3. Zygomaticomalar Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4. Anterior Auricular Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
5. Posterior Deep Temporal Artery ............................ 21
6. Terminal Branches of the Superficial Temporal Artery. . . . . . . . . . 22
C. VenousReturn.............................................. 22
Table of Contents XI
VIII. Internal Maxillary Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
A. Trunk of the Internal Maxillary Artery . . . . . . . . . . . . . . . . . . . . . . . . . 22
1. Origin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2. First Segment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3. Second (Zygomatic or Pterygoid) Segment. . . . . . . . . . . . . . . . . . . . 23
4. Third, Pterygopalatine Segment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
5. Branches of the Internal Maxillary Artery. . . . . . . . . . . . . . . . . . . . . 24
B. Ascending Cranial and Extracranial Branches of the Internal
Maxillary Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
1. Anterior Tympanic Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2. Accessory Meningeal Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
C. Ascending Extracranial Muscular Branches of the Maxillary Artery. 25
1. Middle Deep Temporal Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2. Anterior Deep Temporal Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
D. Recurrent Branches of the Termination of the Internal Maxillary
Artery. .. . .. . .. . .. . . .. . . . . . . . . . . . . . . .. . . . .. . .. . . . . . . .. . . .. . 26
1. Vidian Artery or Artery of the Pterygoid Canal. . . . . . . . . . . . . . . . 26
2. Pharyngeal Branch of the Internal Maxillary or Pterygopalatine
Artery ........................ " . . . . . . . .. . . . . . . .. . . .. . . .. 26
3. Artery of the Foramen Rotundum ....................... '" . 27
E. Descending Branches of the Internal Maxillary Artery . . . . . . . . . . . . 27
1. Masseteric and Pterygoid Branches .......................... 27
2. Inferior Dental Artery ..................................... 27
3. Buccal Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
F. Anterior Branches of the Internal Maxillary Artery. . . . . . . . . . . . . . . 29
1. Posterior Superior Dental Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
2. Infraorbital Artery ........................................ 29
3. Descending or Superior Palatine Artery ...................... 30
G. Sphenopalatine Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
1. Origin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
2. External Branch: Posterior Lateral Nasal or Lateral Spheno-
palatine Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3. Posterior Septal, Nasal Palatine, or Medial Sphenopalatine Artery 32
H. Middle Meningeal Artery and Its Branches. . . . . . . . . . . . . . . . . . . . . . 33
1. Arterial Trunk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2. Branches of the Middle Meningeal Artery. . . . . . . . . . . . . . . . . . . . . 33
a) Extracranial Branches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
b) Basal Branches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
c) Anterior Branches ...................................... 33
d) Posterior Branches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
e) Terminal Branches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3. Territory of the Middle Meningeal Artery. . . . . . . . . . . . . . . . . . . . . 34
4. Anastomoses With Other Arteries. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
5. Capillary Phase of Selective Middle Meningeal Arteriography.
"Durography" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
6. Venous Drainage of the Meninges . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
7. Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Chapter 2
Cervico-Cephalic Vascular Territories
I. Superficial Cutaneous Territories of the Face ...................... " 125
A. Supply of the Face........................................... 125
1. Submental Territory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
XII Table of Contents
2. Mental Territory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 125
3. Blood Supply of the Lips. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 126
4. Nasal Territory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
5. Blood Supply of the Cheek ................................. 129
a) Branches of the Facial Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
b) Branches of the Transverse Facial Artery. . . . . . . . . . . . . . . . . .. 129
c) Branches of the Infraorbital Artery. . . . . . . . . . . . . . . . . . . . . . .. 129
d) Branches of the Buccal Artery ............................ 129
6. Masseteric Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
a) Masseteric Branches of the Facial Artery. . . . . . . . . . . . . . . . . . . 129
b) Masseteric Branches of the Transverse Facial Artery . . . . . . . .. 129
c) Masseteric Branches of the Internal Maxillary Artery ........ 129
7. Zygomaticomalar Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 129
a) Feeding Arteries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 129
b) Anastomotic Pathways. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
B. Anastomotic Arcades in the Facial Region. . . . . . . . . . . . . . . . . . . . . . 130
1. Vertical Anastomotic Pathways. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
a) Postero-Lateral Anastomoses. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 130
b) Antero-Lateral Anastomoses. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 130
c) Anterior Anastomoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 130
2. Horizontal Anastomotic Pathways. . . . . . . . . . . . . . . . . . . . . . . . . .. 130
a) Mandibular and Symphyseal Region. . . . . . . . . . . . . . . . . . . . . .. 130
b) Facio-Labial Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 130
c) Nasal Region. . . . . .. . .. . .. . . . .. . . . .. . . . .. . . . . . . . . . . . . . .. 131
d) Frontal and Glabellar Regions. . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
C. Vascularisation of the Scalp. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
D. Vascularisation of the Pinna. . . . .. . . . . . .. . . . .. . . . . .. . . .. . .. . .. 131
II. Mucosal Territories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
A. Supply of the Buccal Cavity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 131
B. Soft Palate and Pillars of the Fauces ........................... 132
C. Vascularisation of the Oropharynx. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 132
D. Blood Supply of the Nasopharynx or Cavum Oris. . . . .. . . . . .. . . .. 132
E. Blood Supply of the Nasal Fossae............................. 132
1. Nasal Septum. . . . . . . . .. . . . . . . . .. . . . . .. . . . .. . . .. . . .. . . .. . .. 132
2. Conchae, Meatuses, and Ethmoid Regions. . . . . . . . . . . . . . . . . . . . 133
F. Blood Supply of the Maxillary Antra. . . . . . . . . . . . . . . . . . . . . . . . . . . 133
G. Supply of the Alveolus and Teeth. . . . .. .. . . .. . . .. . . .. . . . .. . . ... 133
III. M eningea/ and Osseous Territories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
A. Supply of the Cranial Vault and Associated Meninges ............ 133
B. Vascularisation of the Falx Cerebri and the Tentorium. . . . . . . . . . . . 134
C. Supply of the Skull Base. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 134
1. Exocranial Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 134
2. Endocranial Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 135
a) Squamo-Occipital Portion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 135
b) Meninges of the Petrous Portion of the Posterior Fossa. . . . . . . 135
c) Meningeal Supply of the Clivus . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
d) Supply of the Middle Cranial Fossa ....................... 135
e) Meningeal Supply of the Anterior Cranial Fossa. . . . . . . . . . . . . 136
IV. Orbital Territory ............................................... 136