Case ReportAnomalous “Middle” Meningeal Artery from Basilar Artery and Implications for Neuroendovascular Surgery: Case Report and Review of Literature
Section snippets
Background and Importance
The middle meningeal artery (MMA) and its branches are regularly catheterized to deliver embolic agents in treating dural arteriovenous fistulas and tumors. Recently MMA embolization has been performed for subdural hematomas.1 The prerequisite for embolization is performing a thorough diagnostic angiogram in order to detect dangerous anastomoses and anatomic variations that may impact therapeutic decisions. One example is the anomalous origin of MMA. Here we present a patient with subdural
Methods: Literature Review
We performed a systematic literature review in PubMed with key words “(middle meningeal artery) AND (origin OR anastomosis OR abnormal OR variant OR variation OR anomalous) AND (basilar).” Twenty-six papers resulted, of which 20 were excluded (9 non English, 11 nonrelevant). Six papers reporting 9 cases with a total of 10 arteries were found. One additional paper describing 1 case with 1 artery was found from cross references.
Clinical Presentation
An 82-year-old gentleman on aspirin with a recurrent left-sided chronic subdural hematoma (Figure 1) presented for MMA embolization. Left external carotid artery injection revealed an MMA arising from the internal maxillary artery (IMAX) that, after entering the middle fossa floor, continued in the distribution of the posterior division of MMA (Figure 2A and B). Vertebral artery injection revealed an unusual left pontine artery branch of the basilar artery arising below the superior cerebellar
Literature Review
Table 1 provides an overview of pertinent papers. Most described cases were unilateral. The left side was commonest (7 vs. 4 on right). The majority were detected on angiography performed for diagnostic reasons. One was detected during attempted embolization of an extraaxial tumor. The anomalous artery was not used for embolization. Our case was diagnosed during targeted MMA embolization for subdural hematoma.
Embryology of Middle Meningeal Artery and Foramen Spinosum
The embryology of the MMA relates to the hyoid (HA) and stapedial artery (SA) along
Conclusion
Recognition of the rare anomalous origin of MMA has practical value in determining the feasibility of embolization for vascular intracranial diseases including SDH. A thorough diagnostic angiogram is a prerequisite to safe neuroendovascular therapy. Embryologic-angiographic correlation provides a more solid academic basis for clinical decision making.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.