The variations of the middle meningeal artery within the middle cranial fossa

Abstract Objective: To define the arterial supply to the facial nerve that crosses the floor of the middle cranial fossa. Methods: Twenty-five middle fossae from adult cadaveric-injected specimens were examined under 3 to 40× magnification. Results: The petrosal branch of the middle meningeal artery is the sole source of supply that crossed the floor of the middle fossa to irrigate the facial nerve. The petrosal artery usually arises from the first 10-mm segment of the middle meningeal artery after it passes through the foramen spinosum, but it can arise within or just below the foramen spinosum. The petrosal artery is commonly partially or completely hidden in the bone below the middle fossa floor. It most commonly reaches the facial nerve by passing through the bone enclosing the geniculate ganglion and tympanic segment of the nerve and less commonly by passing through the hiatus of the greater petrosal nerve. The petrosal artery frequently gives rise to a branch to the trigeminal nerve. The middle meningeal artery was absent in one of the 25 middle fossae, and a petrosal artery could not be identified in four middle fossae. The petrosal arteries were divided into three types based on their pattern of supply to the facial nerve. Conclusion: The petrosal artery is at risk of being damaged during procedures in which the dura is elevated from the floor of the middle fossa, the middle fossa floor is drilled, or the middle meningeal artery is embolized or sacrificed. Several recommendations are offered to avoid damaging the facial nerve supply while performing such interventions.

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MORPHOMETRIC AND MORPHOLOGICAL STUDY ON FORAMEN OVALE

10.36106/gjra/9200804 ◽

2021 ◽

pp. 21-22

Author(s):

S. Saravana Baskar ◽

S. Karthick

Keyword(s):

Morphological Study ◽

South India ◽

Middle Cranial Fossa ◽

Mean Value ◽

Foramen Ovale ◽

Male And Female ◽

Foramen Rotundum ◽

Cranial Fossa ◽

The Mean ◽

Meningeal Artery

Background: Foramen ovalee is an important foramen of the middle cranial fossa. Foramen ovalee is situated in the greater wing of the sphenoid bone, posterior to the foramen rotundum and lateral to the lingula and posterior end of the carotid groove. Through the foramen ovale the mandibular nerve, accessory meningeal artery and lesser petrossal nerve are passing through it. The shape of foramen ovale is ovale in shape as compare to other foramina of the skull, its shape and size is quite variable. Meterials And Methods: A total 250 skulls were used for this study. The skulls were collected with I MBBS student from different medical colleges in south India. Skulls in poor conditions or skulls with partly damaged surroundings of the foramen ovalee were not considered. Maximum length and width of foramen ovalee was measured. Variation in right and left side and sex difference in length and width were calculated, the variations in shape also recorded. Results: The mean value of length of left foramen ovale is 8.5+1.32mm and right was 8.9+1.67mm. In female it was 8.7+1.67mmandmalewas 8.4+1.71mm. Themean value ofwidth of left foramen ovale is 3.7+1.03mmand right was 3.9+0.98mm. In female it was 3.8+0.92mm andmale was 3.7+1.02mm.The shape of foramen ovalewas ovale in 69% of skulls, almond in 29% of skulls and round was 2% of skulls. Conclusion: The present study conclude that there is signicant difference between sizes of right and left side foramen ovale and found that between male and female foramen ovale sizes also not shown any signicance difference. Foramen ovale has practical signicance to both neurosurgical and functional cranial neuroanatomy as it provides transcutaneous approaches to the skull base especially in cases of trigeminal neuralgia, as the Gasserion ganglion can be approached through it.

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Bony Canals Along The Course of Middle Meningeal Artery In Dry Skulls

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401655 ◽

2012 ◽

Vol 01 (01) ◽

pp. 019-023 ◽

Cited By ~ 1

Author(s):

Bindu Aggarwal ◽

Madhur Gupta ◽

Harsh Kumar

Keyword(s):

Middle Cranial Fossa ◽

Middle Meningeal Artery ◽

Branching Pattern ◽

Artery Ligation ◽

Posterior Branch ◽

Anterior Branch ◽

Bony Canal ◽

Subdural Hemorrhages ◽

The Right ◽

Meningeal Artery

Abstract Background : The middle meningeal artery courses in the middle cranial fossa and divides into two or three branches. The branches of the artery are sometimes enclosed within a bony canal. The artery and its branches are likely to get tom in cases of epidural hematomas and may require ligation. Aims: The aim of the study is to report the variations in the branching pattern of middle meningeal artery and incidence of bony canals along the course of these branches. Materials: The study material consisted of 77 bases of dry skulls (154 sides) and the findings were supplemented with dissection of four cadaveric skulls. Results and Conclusions : The length of stem of middle meningeal artery, from foramen spinosum to its division into branches varied from 0.56 to 5.83 mm on the right side and 0.58- 7.53mm on the left. The mean length of the stem was 3.04 on the right side and 3.01 on the left (S D ± 1.4). The middle meningeal artery divided into anterior and posterior branches in all the sides of skull. A middle branch constituting a third branch of middle meningeal artery was observed in 44.15% (68 sides) which arose either from its anterior 35.29% (24 sides) or posterior branch 64.71 % (44 sides). Bony canals were observed in 39.61 % (61 sides). The anterior branch was enclosed in a bony canal in 37.66% (58 sides) and the posterior branch in 1.94% (3 sides). The variations in the course, branching pattern and bony canals along middle meningeal artery are of clinical significance while treating extradural and subdural hemorrhages as due to these variations and presence of bony canal in course of middle meningeal artery, ligation of the vessel may be totally or partially insufficient.

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The Anterolateral Triangle: Implications for a Transnasal Prelacrimal Approach to the Floor of the Middle Cranial Fossa

American Journal of Rhinology and Allergy ◽

10.1177/1945892420922757 ◽

2020 ◽

Vol 34 (5) ◽

pp. 671-678

Author(s):

Lifeng Li ◽

Nyall R. London ◽

Daniel M. Prevedello ◽

Ricardo L. Carrau

Keyword(s):

Surgical Navigation ◽

Middle Cranial Fossa ◽

Middle Meningeal Artery ◽

Nasolacrimal Duct ◽

Lateral Nasal Wall ◽

Foramen Ovale ◽

Bony Ridge ◽

Greater Superficial Petrosal Nerve ◽

Foramen Rotundum ◽

Cranial Fossa

Background The anterolateral triangle enclosed by the foramen rotundum and foramen ovale constitutes part of the floor of the middle cranial fossa (MCF). Objective To assess the feasibility of a transnasal prelacrimal approach for accessing the floor of MCF via an anterolateral triangle corridor and to determine the extent of maximal exposure while safeguarding neurovascular structures. Methods A transnasal prelacrimal approach was performed in 5 cadaveric specimens (10 sides). Following the identification of foramen rotundum and foramen ovale, the bony ridge between 2 was drilled to expose the MCF. The temporal lobe dura was then elevated laterally, and the distances from foramen ovale to the respective borders of the area of the MCF window were measured using a surgical navigation device. Results The MCF was exposed with a 0° scope in all specimens also exposing significant landmarks including the middle meningeal artery, greater superficial petrosal nerve, superior petrous sinus, and arcuate eminence. Average distances from foramen ovale to the anterior, posterior, and lateral exposed borders were 22.86 ± 1.87 mm, 27.24 ± 0.94 mm, and 24.23 ± 1.61 mm, respectively. The average area of exposed MCF window was 554.12 ± 60.22 mm2. Preservation of vidian nerve, greater palatine nerve, lateral nasal wall, and nasolacrimal duct was possible in all 10 sides. Conclusion It is feasible to access the floor of MCF via an endoscopic transnasal prelacrimal approach with seemingly low risk.

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Embolization of dural arteriovenous fistula of the anterior cranial fossa through the middle meningeal artery with Onyx

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2013.11.013 ◽

2014 ◽

Vol 117 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Jian-Ping Deng ◽

Jiang Li ◽

Tao Zhang ◽

Jia Yu ◽

Zhen-Wei Zhao ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Middle Meningeal Artery ◽

Anterior Cranial Fossa ◽

Cranial Fossa ◽

Meningeal Artery

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Intra-arterial onyx embolisation of sphenobasilar sinus fistula using pressure cooker technique: case report and review of the literature

The Neuroradiology Journal ◽

10.1177/1971400920972512 ◽

2020 ◽

pp. 197140092097251

Author(s):

Chandra Dev Sahu ◽

Nishant Bhargava

Keyword(s):

Venous Drainage ◽

Middle Cranial Fossa ◽

Middle Meningeal Artery ◽

Cerebral Vein ◽

Venous Reflux ◽

Endovascular Embolisation ◽

Superficial Middle Cerebral Vein ◽

Cortical Venous Reflux ◽

Cranial Fossa ◽

Cortical Venous Drainage

Dural arterio-venous fistulas of the middle cranial fossa may occur within the dura of lesser or greater sphenoid wings. Lesser sphenoid wing fistulas rarely recruit cortical venous drainage and mostly drain in the cavernous sinus. On the other hand, greater sphenoid wing dural fistulas, also known as paracavernous fistulas or sphenobasilar and sphenopetrosal sinus fistulas, are much more notorious as they almost always connect with the superficial middle cerebral vein resulting in secondary cortical venous reflux and varix formation. Curative transarterial or transvenous endovascular embolisation of fistulous connection is the primary therapeutic strategy, particularly using onyx via the transarterial approach. In the present case we describe a 62-year-old man who presented with significant subarachnoid haemorrhage, intraparenchymal and intra-ventricular bleed. Digital subtraction angiography showed a middle cranial fossa dural arteriovenous fistula in the region of the sphenobasilar sinus with cortical venous reflux and varix formation. The patient underwent successful transarterial endovascular embolisation with complete elimination of the fistula using onyx 34, onyx 18, squid 12 and a Scepter XC balloon using the pressure cooker technique. We also report the development of facial nerve palsy due to inadvertent reflux of onyx in the petrosal branch of the middle meningeal artery.

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Bony Tunnel Formation Associated with the Distal Segment of the Frontal Branch of the Middle Meningeal Artery

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1676353 ◽

2018 ◽

Vol 80 (05) ◽

pp. 480-483

Author(s):

Deivis de Campos ◽

Caroline Haubert da Silveira ◽

Geraldo Pereira Jotz ◽

Tais Malysz

Keyword(s):

Anatomical Variations ◽

Middle Cranial Fossa ◽

Middle Meningeal Artery ◽

Distal Segment ◽

Human Anatomy ◽

Anatomy Laboratory ◽

Pass Through ◽

The Right ◽

Meningeal Artery ◽

Frontal Branch

AbstractThe knowledge of certain anatomical variations is fundamental and any surgeon who operates without that knowledge may encounter difficulty during surgery. In this context, there is the middle meningeal artery (MMA) which also engenders considerable clinical interest due to its location. The MMA is predominantly periosteal, irrigating the bone and dura mater. It enters the floor of the middle cranial fossa through the foramen spinosum, travels laterally through a middle fossa bony ridge, and curves anteriorly over the upper-greater wing of the sphenoid where it divides into parietal and frontal branches at a variable point. Occasionally, the distal segment of the frontal branch may pass through a bony tunnel of variable size. To the best of our knowledge, there is no evidence in the current literature on the incidence of this rare bony tunnel. Therefore, we decided to investigate the incidence of this bony tunnel in 85 dry skulls of adults (both genders) belonging to the didactic collection of the Human Anatomy Laboratory of the Universidade de Santa Cruz do Sul, Brazil. All the skulls were examined bilaterally for the presence or absence of the bony tunnel associated with the distal segment of the frontal branch of the MMA. Of the 85 skulls analyzed, the bony tunnel was present on the right side in 1.18% and on the left side in 5.88% (p = 0.045). Thus, in the studied sample, there was a significant tendency for this bony tunnel to be formed on the left side.

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