Abstract
The middle meningeal artery is the major human dural artery. Its origin and course can vary a great deal in relation, not only with the embryologic development of the hyostapedial system, but also because of the relationship of this system with the ICA, ophthalmic artery, trigeminal artery, and inferolateral trunk. After summarizing these systems in the first part our review, our purpose is to describe, in this second part, the anatomy, the possible origins, and courses of the middle meningeal artery. This review is enriched by the correlation of each variant to the related embryologic explanation as well as by some clinical cases shown in the figures. We discuss, in conclusion, some clinical conditions that require detailed knowledge of possible variants of the middle meningeal artery.
Highlights
Altmann[5] was the first investigator to describe a case of basilar artery origin of the middle meningeal artery (MMA) in his monumental article about anomalies of the carotid system but failed to give clear embryologic explanation of the anatomic variation. He described the origin of the artery between the AICA and PICA, and its course as “accompanying the acousticfacial nerve,” passing through the internal acoustic canal to reach the superior branch of the stapedial artery (SA)
The foramen spinosum is enlarged, the cochlear promontory is eroded, and the internal maxillary artery (IMA) arises from the second aortic arch (the SA) instead of the external carotid artery. Such an anatomic variant could be explained by the absence of an embryologic annexation of the maxillomandibular branch by the ventral pharyngeal artery, details of which are described in part 1 of our Complete ophthalmic artery (OA) origin of the MMA
At the level arises from the ICA in its tympanic segment and passes through of the foramen spinosum, the artery bends anteriorly and laterally the stapes to have the same course described in the previous para- to follow the temporal fossa
Summary
Normal embryology Anastomosis between SA and trigeminal artery; anastomosis between SA and lateral pontine artery Anastomosis between inferolateral trunk and SA Regression of the proximal part of the maxillomandibular branch; persistence of the intratympanic segment of the SA Lack of annexation of the maxillomandibular branch by the ventral pharyngeal artery; persistence of the intratympanic segment of the SA Agenesis of the first and second segments of the ICA; intratympanic anastomosis between inferior tympanic and caroticotympanic arteries; persistence of the intratympanic segment of the SA Intratympanic anastomosis between inferior and superior tympanic arteries; regression of the proximal part of the maxillomandibular branch; persistence of the intratympanic segment of the SA No clear explanation. Altmann[5] was the first investigator to describe a case of basilar artery origin of the MMA in his monumental article about anomalies of the carotid system but failed to give clear embryologic explanation of the anatomic variation. He described the origin of the artery between the AICA and PICA, and its course as “accompanying the acousticfacial nerve,” passing through the internal acoustic canal to reach the superior branch of the stapedial artery (SA). Anatomic variant could be explained by the absence of an embryologic annexation of the maxillomandibular branch (of the SA) by the ventral pharyngeal artery, details of which are described in part 1 of our
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