Variability of the Middle Meningeal Artery Subject to the Shape of Skull

Abstract

Objectives Endovascular embolization of the middle meningeal artery (MMA) is currently considered one of the basic methods to treat acute bleeding and a posttraumatic aneurysm. The present research correlates the morphological characteristics of the MMA with individual skull shape.

Design A prospective cohort study.

Setting Hospital of University of Jordan (Amman, Jordan) from 2012 to 2013.

Participants A total of 50 patients without known vascular pathology in the carotid system underwent routine magnetic resonance angiography examination of the head and neck.

Main Outcome Measures The length and outer diameter of extracranial, intraosseous, and intracranial segments of the MMA were measured in patients with dolichocephalic, mesocephalic, and brachycephalic types of skulls.

Results The brachycephalic patients have the most inauspicious anatomical precondition for endovascular intervention of the MMA due to the narrowest lumen of the vessel, high probability of a tortuous extracranial part, and pronounced inflexion at the transmission of the intraosseous segment to the intracranial one.

Conclusions The morphological characteristics of the MMA have a close correlation with individual skull shape.

Keywords

middle meningeal artery - endovascular embolization - posttraumatic aneurism

• References

• 1 Mantini S, Bruner E, Colaiacomo B , et al. The anatomical variability and the functional role of the middle meningeal artery. Ital J Anat Embryol 2010; 115: 101
• 2 Talib JA. Anatomical variation in the course, branches, and metrical measurement of the grooves, of the middle meningeal artery inside the skull. Tikrit Medical Journal. 2009; 15 (2) 38-41
• 3 Bruneau M, Gustin T, Zekhnini K, Gilliard C. Traumatic false aneurysm of the middle meningeal artery causing an intracerebral hemorrhage: case report and literature review. Surg Neurol 2002; 57 (3) 174-178 ; discussion 178
• 4 Babu ML, Bhasin SK, Kumar A. Extradural hematoma—an experience of 300 cases. JK Science. 2005; 7 (4) 205-207
• 5 Araujo JL, Aguiar UdoP, Todeschini AB, Saade N, Veiga JC. Epidemiological analysis of 210 cases of surgically treated traumatic extradural hematoma. Rev Col Bras Cir 2012; 39 (4) 268-271
• 6 Wang CH, Lee HC, Cho DY. Traumatic pseudoaneurysm of the middle meningeal artery: possible indicators for early diagnosis in the computed tomography era. Surg Neurol 2007; 68 (6) 676-681 ; discussion 681–682
• 7 Kiyosue H, Hori Y, Okahara M , et al. Treatment of intracranial dural arteriovenous fistulas: current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization. Radiographics 2004; 24 (6) 1637-1653
• 8 Suzuki S, Endo M, Kurata A , et al. Efficacy of endovascular surgery for the treatment of acute epidural hematomas. AJNR Am J Neuroradiol 2004; 25 (7) 1177-1180
• 9 Shah QA, Hurst RW. Endovascular treatment of a traumatic pseudo aneurysm of the middle meningeal artery. Available at: http://radiology.casereports.net/index.php/rcr/article/view/22/171
• 10 Bortoluzzi M, Pavia M. Endovascular treatment of incoercible epistaxis and epidural cerebral hematoma. A case report. Interv Neuroradiol 2006; 12 (3) 233-236
• 11 Wallace G, Clemente S, Lenker J , et al. Intracranial stent and method of use. US patent 0243224 A1. October 2, 2008
• 12 Mantini S, Bruner E, Colaiacomo B , et al. An angio-tomographic approach to the study of the variation of the middle meningeal artery in humans. Ital J Anat Embryol 2011; 116 (1) 110
• 13 Klisovic D, Sikic E, Krmpotic-Nemanic J. Variations of the middle meningeal artery: Significance for surgery and practice. Clin Anat 1993; 6 (5) 289-294
• 14 Banister M. Skeletal system. In: Williams P, Dyson M, Dussak JE, , et al, eds. Grey's Anatomy. 38th ed. London, UK: Elbs with Churchill Livingston; 1995: 607-612
• 15 Kolar JC, Salter EM. Craniofacial Anthropometry: Practical Measurements of the Head and Face for Clinical, Surgical and Research Use. Springfield, IL: Charles C Thomas; 1997
• 16 Kornieieva MA. Morphological Interrelations of the Dural Sinuses of the Skull Base with the Venous Plexuses of Face in the Early Period of Human Ontogenesis [PhD dissertation]. Kharkov, Ukraine: Kharkiv National Medical University; 2007
• 17 Bullitt E, Gerig G, Pizer SM, Lin W, Aylward SR. Measuring tortuosity of the intracerebral vasculature from MRA images. IEEE Trans Med Imaging 2003; 22 (9) 1163-1171
• 18 Jani B, Rajkumar C. Ageing and vascular ageing. Postgrad Med J 2006; 82 (968) 357-362
• 19 Kovacic JC, Moreno P, Nabel EG, Hachinski V, Fuster V. Cellular senescence, vascular disease, and aging: part 2 of a 2-part review: clinical vascular disease in the elderly. Circulation 2011; 123 (17) 1900-1910
• 20 Virmani R, Avolio AP, Mergner WJ , et al. Effect of aging on aortic morphology in populations with high and low prevalence of hypertension and atherosclerosis. Comparison between occidental and Chinese communities. Am J Pathol 1991; 139 (5) 1119-1129
• 21 Ustün ME, Büyükmumcu M, Seker M, Karabulut AK, Uysal II, Ziylan T. Possibility of middle meningeal artery-to-petrous internal carotid artery bypass: an anatomic study. Skull Base 2004; 14 (3) 153-156