Origin of the ophthalmic artery from the middle meningeal artery.

Abstract

ORIGIN of the ophthalmic arte ry from the middle meningeal artery has been described in anatomic specimens, and its roentgen appeara nce has been mentioned in the literature (1- 4). The only published radiograph is in the German literature. Keller (5) demonstrated the vessel an giographically in a patient with a tumor of the na sopharynx which compressed the internal car otid artery on the same side. In the following case, origin of t he ophthalmic artery from th e middle meningeal artery was demonstra ted angiographically. A 55-year-old man was admitted to the Neurology Service at Cincinnati General Hospital with signs of cerebral vascular insufficiency. Angiography of all 4 main cerebral vessels demonstrated occlusion of th e anterior branches of th e right middle cerebral artery. The right vertebra l artery was occluded 1 ern from it s origin, but the left ver tebral artery was patent. The left carotid artery revealed th e ophth almic ar ter y ari sing as a branch of the middle meningeal artery but was otherwise normal (Figs. 1 and 2). Harvey and Howard (2) illu strated an ana tomic dissection in which the opht halmic artery originate d from the anterior branch of the middle menin geal artery, passed through the superior orbital fissur e, and the n assumed a normal cour se. This variation was also seen in (j of 170 specimens prepared by Hayreh (1) . These authors stressed that in these instances the central ret inal artery usually originates from the in terRE al carotid artery , even though the rest of the ophthalmic system arises from the middle meningeal artery. Gabriele and Bell (9) illustrat ed and discussed the origin of the middle meningeal artery from the ophthalmic ar tery . They mentioned origin of the ophthalmic ar tery from the middle meningeal artery as a possible variati on. However , th ey presented no examp les. Failure of fet al development or atrophy of the initi al portion of the ophthalmic artery is the logical expla nat ion of this anomaly. Embryologically the hyoid artery (a branch of th e intern al carotid artery) gives rise to the stapedial ar tery which in turn gives origin to th e middle meningeal artery and then continues into the orbit as a suprao rbital branch. Normally the attachment of the stapedial artery to the intern al carot id system und ergoes atro phy , and the stapedial ar tery sys tem then becomes connected to th e external car otid system. The middle meningeal ar tery th en becomes a major branch of the ext ern al carotid sys tem with the supraorbit al artery a min or bran ch of the anterior division of the middle meningeal artery . If the proximal connection of the ophthalmic artery to the intern al caroti d atrophies or fails to develop. however , th en th e supraorbital bra nch of th e middle meningeal artery may become the primary blood supply for the orbit (1, 4). In our pati ent we cannot be sure where the central retinal ar tery arises but, as st at ed previously , this usu ally remain s a branch of th e internal carotid artery.