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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(04): e339-e348
DOI: 10.1055/s-0041-1733863
Review Article | Artigo de Revisão

Anatomy of the Middle Meningeal Artery

Anatomia da artéria meníngea média
Marco Aurélio Ferrari Sant'Anna 
1   Hospital Celso Pierro, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
,
Leonardo Luca Luciano 
2   School of Medicine, Universidade Federal de Alfenas, Alfenas, MG, Brazil
,
Pedro Henrique Silveira Chaves
3   Centro Universitário Atenas, Paracatu, MG, Brazil
,
Leticia Adrielle dos Santos
4   Universidade Federal do Sergipe, Aracaju, SE, Brazil
,
Rafaela Gonçalves Moreira
5   Faculdade Atenas, Passos, MG, Brazil
,
Rian Peixoto
6   School of Medicine, Faculdade Santa Marcelina, São Paulo, SP, Brazil
,
Ronald Barcellos
7   Neurosurgery Department of the Hospital de Urgência de Sergipe Governador João Alves Filho, Aracaju, SE, Brazil
8   Neurosurgery Department of the Fundação de Beneficência Hospital de Cirurgia Aracaju, SE, Brazil
,
Geraldo Avila Reis
7   Neurosurgery Department of the Hospital de Urgência de Sergipe Governador João Alves Filho, Aracaju, SE, Brazil
8   Neurosurgery Department of the Fundação de Beneficência Hospital de Cirurgia Aracaju, SE, Brazil
,
Carlos Umberto Pereira
8   Neurosurgery Department of the Fundação de Beneficência Hospital de Cirurgia Aracaju, SE, Brazil
,
Nícollas Nunes Rabelo 
9   Neurosurgery Department, Neurosurgery Service of HGUSE and the Benefit Foundation Hospital of Surgery, Aracaju, SE, Brazil
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Abstract

Introduction The middle meningeal artery (MMA) is an important artery in neurosurgery. As the largest branch of the maxillary artery, it provides nutrition to the meninges and to the frontal and parietal regions. Diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (TAVF), Moya-Moya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine, and meningioma, may be related to the MMA. The aim of the present study is to describe the anatomy of the MMA and to correlate it with brain diseases.

Methods A literature review was performed using the PubMed, Scielo, Scientific Direct, Ebsco, LILACS, TripDataBase and Cochrane databases, with the following descriptors: neurosurgery, neuroanatomy, meninges and blood supply.

Discussion The MMA is embedded in a cranial groove, and traumatic or iatrogenic factors can result in MMA-associated pseudoaneurysms or arteriovenous fistulas (AVFs). In hemodynamic stress, true aneurysms can develop. Arteriovenous fistulas, pseudoaneurysms, and true aneurysms can be effectively treated by endovascular or surgical removal. In MMD, the MMA plays a role in the development and in the improvement of collateral circulation. Finally, in cases of CSDH, when standard surgery and drainage fail, MMA embolization can constitute a great alternative.

Conclusion The MMA is a relevant structure for the understanding of neurosurgical diseases. In conclusion, every neurosurgeon must know the anatomy of the MMA sufficiently to correlate it with the diagnosed pathology, thus obtaining treatment effectiveness and preventing brain lesion.

Resumo

Introdução A artéria meníngea média (AMM) se configura como um importante vaso arterial na neurocirurgia. É o maior ramo da artéria maxilar e fornece nutrição às meninges e às regiões frontal e parietal. Doenças, incluindo fístula arteriovenosa dural (FAVD), pseudoaneurisma, aneurisma verdadeiro, fístula arteriovenosa traumática (FAVT), doença de Moya-Moya (DMM), hematoma subdural crônico (HSDC) recorrente, migrânea e meningioma podem estar relacionadas à AMM. O objetivo do presente estudo é descrever a anatomia da AMM e sua correlação com as doenças envolvidas.

Métodos Uma revisão da literatura foi realizada utilizando as bases de dados PubMed, Scielo, Scientific Direct, Ebsco, LILACS, TripDataBase e Cochrane, com os seguintes descritores: neurocirurgia, neuroanatomia, meninges e irrigação sanguínea.

Discussão A AMM está inserida em um sulco do crânio, e fatores traumáticos ou iatrogênicos podem resultar em pseudoaneurismas ou em fístulas arteriovenosas (FAVs) associadas. Quando o estresse hemodinâmico aumenta, aneurismas verdadeiros podem se desenvolver. Fístulas arteriovenosas, pseudoaneurismas e aneurismas verdadeiros podem ser efetivamente tratados por remoção endovascular ou de forma cirúrgica. Na DMM, a AMM desempenha um papel muito importante no desenvolvimento e na compensação da circulação colateral. Em casos de HSDC recidivante, quando a cirurgia convencional e drenagem falham, a embolização da AMM pode ser uma ótima opção.

Conclusão A AMM é uma estrutura anatômica importante no entendimento das doenças neurocirúrgicas. Portanto, todo neurocirurgião deve conhecer a anatomia da AMM e estar apto a correlacioná-la com a patologia envolvida, obtendo, assim, efetividade no tratamento e prevenção de lesão cerebral.

Keywords

neurosurgery - neuroanatomy - middle meningeal artery - meningeal artery

Palavras-chave

neurocirurgia - neuroanatomia - artéria meníngea média - artéria meníngea


Publication History

Received: 26 May 2020

Accepted: 09 March 2021

Article published online:
03 August 2021

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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