Impact of anomalous origin of the ophthalmic artery from the middle meningeal artery on selection of surgical approach to skull base meningioma

Ophthalmic artery (OA) is known for anomalous origin and aberrant course probably attributable to its complex embryology. Anomalous origin of OA can be associated with intracranial aneurysm. Anomalous origins have been reported from middle meningeal artery (MMA), cavernous carotid, posterior communicating, anterior cerebral and basilar artery. Even though bilateral anomalous origin of OA from MMA is a rare finding, to the author’s best knowledge, association of above condition with bilateral internal carotid artery aneurysms has not been described in the literature. We present a case of such anomalous bilateral OA originating from MMA and associated with bilateral internal carotid artery aneurysms. We have also reviewed the pertinent literature regarding anomalous OA origin.

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Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1718767 ◽

2020 ◽

Author(s):

Ravi Sankar Manogaran ◽

Raj Kumar ◽

Arulalan Mathialagan ◽

Anant Mehrotra ◽

Amit Keshri ◽

...

Keyword(s):

Skull Base ◽

Surgical Approach ◽

Nerve Palsy ◽

Tertiary Care ◽

Surgical Approaches ◽

Microsurgical Anatomy ◽

Complete Excision ◽

Lateral Skull Base ◽

The Individual ◽

Selection Of

Abstract Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

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Response to “Some observations over the article “Evaluation of the anastomoses between the ophthalmic artery and the middle meningeal artery by superselective angiography””

Surgical and Radiologic Anatomy ◽

10.1007/s00276-020-02624-2 ◽

2021 ◽

Author(s):

Hilal Akdemir Aktaş ◽

Kadriye Mine Ergun ◽

İlkan Tatar ◽

Anıl Arat ◽

Kadir Mutlu Hayran

Keyword(s):

Ophthalmic Artery ◽

Middle Meningeal Artery ◽

Superselective Angiography ◽

Meningeal Artery

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Republished: Trigeminocardiac reflex caused by selective angiography of the middle meningeal artery

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012517.rep ◽

2016 ◽

Vol 9 (3) ◽

pp. e10-e10 ◽

Cited By ~ 1

Author(s):

Takamitsu Tamura ◽

David E Rex ◽

Miklos G Marosfoi ◽

Ajit S Puri ◽

Matthew J Gounis ◽

...

Keyword(s):

High Pressure ◽

Intracranial Pressure ◽

Ophthalmic Artery ◽

Middle Meningeal Artery ◽

Interesting Case ◽

Contrast Injection ◽

Increased Intracranial Pressure ◽

Selective Angiography ◽

Trigeminocardiac Reflex ◽

Meningeal Artery

We describe an interesting case of trigeminocardiac reflex (TCR) caused by selective angiography of the middle meningeal artery (MMA). A 28-year-old woman presented with a symptomatic meningioma. Preoperative tumour embolisation was performed. In the procedure, when selective MMA angiography was done with Omnipaque 300 mg I/mL for 3 mL by manual injection, the patient complained of flashing lights in her eye followed by vomiting and bradycardia down to 40 bpm without increased intracranial pressure signs. On selective MMA angiography, the choroidal crescent and arteries of the periorbital region were opacified by anastomosis from the MMA via the meningo-ophthalmic artery. We diagnosed that her symptoms were caused by selective MMA angiography leading to high pressure stimulation towards the ophthalmic nerve innervation around the orbit as a TCR. We suggest that the operator should be prepared to manage TCR during treatment with expected selective MMA angiography, and gentle low pressure contrast injection should be attempted.

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Variant middle meningeal artery origin from the ophthalmic artery: a case report

Surgical and Radiologic Anatomy ◽

10.1007/s00276-014-1272-z ◽

2014 ◽

Vol 37 (1) ◽

pp. 105-108 ◽

Cited By ~ 10

Author(s):

David Kimball ◽

Heather Kimball ◽

R. Shane Tubbs ◽

Marios Loukas

Keyword(s):

Case Report ◽

Ophthalmic Artery ◽

Middle Meningeal Artery ◽

Meningeal Artery

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Persistent dorsal ophthalmic artery and ophthalmic artery arising from the middle meningeal artery diagnosed by MR angiography at 3 T

Surgical and Radiologic Anatomy ◽

10.1007/s00276-013-1085-5 ◽

2013 ◽

Vol 35 (9) ◽

pp. 775-782 ◽

Cited By ~ 30

Author(s):

Akira Uchino ◽

Naoko Saito ◽

Masahiro Takahashi ◽

Eito Kozawa ◽

Waka Mizukoshi ◽

...

Keyword(s):

Mr Angiography ◽

Ophthalmic Artery ◽

Middle Meningeal Artery ◽

Meningeal Artery ◽

Persistent Dorsal Ophthalmic Artery

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Embolisation of Branches of the Ophthalmic Artery

Interventional Neuroradiology ◽

10.1177/159101999700300306 ◽

1997 ◽

Vol 3 (3) ◽

pp. 239-245 ◽

Cited By ~ 12

Author(s):

Y. Matsumaru ◽

H. Alvarez ◽

G. Rodesch ◽

P.L. Lasjaunias

Keyword(s):

Optic Nerve ◽

Skull Base ◽

General Anaesthesia ◽

Ophthalmic Artery ◽

Internal Carotid ◽

Visual Disturbance ◽

Functional Testing ◽

Ciliary Arteries ◽

Retinal Artery ◽

Meningeal Artery

Nine patients presenting various orbital and skull base pathologies embolised through the ophthalmic artery are reported. All cases were catheterised beyond the bend around the optic nerve (second portion of the intraorbital ophthalmic artery). Embolisation was carried in all with n-butyl cyano-acrylate without post interventional visual disturbance. Relying on the classic description as well as previous personal work on the ophthalmic artery anatomy and angiographic anatomy, all procedures were performed under general anaesthesia without functional testing. The central retinal artery and the long ciliary arteries arise from the first or second portion of the ophthalmic artery. For embryological reasons no branch to the visual tract can arise from the ophthalmic trunk distal to the origin of the superficial recurrent meningeal artery or the lacrimal artery. Therefore distal catheterisation at least beyond the second portion, (and injection without reflux) makes safe embolisation possible in all variations of internal carotid origin of the ophthalmic stem. Independent from the expected goal of the embolisation, the use of particles in this territory should in our opinion be discouraged.

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Middle Meningeal Origin of the Ophthalmic Artery

Neurosurgery ◽

10.1097/00006123-200108000-00025 ◽

2001 ◽

Vol 49 (2) ◽

pp. 401-407 ◽

Cited By ~ 10

Author(s):

Qingliang Liu ◽

Albert L. Rhoton

Keyword(s):

Ophthalmic Artery ◽

Middle Meningeal Artery ◽

External Carotid Artery ◽

External Carotid ◽

Microsurgical Anatomy ◽

Superior Orbital Fissure ◽

Anatomic Dissection ◽

Retinal Artery ◽

Arteries And Veins ◽

Meningeal Artery

Abstract OBJECTIVE To examine the microsurgical anatomy and clinical significance of an anomalous origin of the ophthalmic artery from the middle meningeal artery. METHODS In the course of an anatomic study of the cavernous sinus, an anomalous ophthalmic artery arising from the middle meningeal artery was found. To further define the anatomy of the region, five additional skulls, in which the arteries and veins were injected with colored latex, were dissected using 3× to 40× magnification. RESULTS The anomalous ophthalmic artery arose from the frontal branch of the middle meningeal artery, passed through the superior orbital fissure, and supplied the entire contents of the orbit, as well as giving rise to the central retinal artery. This study provides the first display of this anomaly in an anatomic dissection. CONCLUSION The ophthalmic artery may infrequently arise from the middle meningeal artery. This anomaly places the ophthalmic artery at risk during procedures in which the dura is elevated from the greater and lesser wings of the sphenoid or when the sphenoid ridge is removed and during embolization procedures involving the branches of the external carotid artery.

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