Angiographic Anatomy of the Middle Meningeal Artery in Relation to Chronic Subdural Hematoma Embolization
- 24 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical Neuroradiology
- Vol. 32 (1), 57-67
- https://doi.org/10.1007/s00062-021-00996-5
Abstract
Purpose Middle meningeal artery (MMA) embolization is emerging as a potential treatment of chronic subdural hematomas (CSDHs). The purpose of this study is to describe MMA angiographic anatomy in relation to CSDH embolization. Methods This retrospective monocentric study was performed on imaging data of MMA embolization procedures for CSDH treatment performed between March 15, 2018 and April 30, 2020. Imaging data, including digital subtraction angiography (DSA) were reviewed independently by two physicians. Discrepancies were resolved by consensus. The MMA bifurcation pattern was analyzed according to an extended Adachi classification. Relations of the MMA with the ophthalmic artery (OA) were also analyzed. Results In this study, 140 MMAs were analyzed. Dominance of the anterior branch (type I) was observed in only 57/140 (41%) MMAs with a moderate interobserver agreement for classifying MMA into type I against all other (κ = 0.53, 95% confidence interval, CI 0.39–0.67). The posterior branch presented a proximal origin (type A), at the point of emergence of the MMA from the foramen spinosum or its immediate vicinity, in 48/135 (36%) MMAs with a very good interobserver agreement for classifying MMAs into type A against all other (κ = 0.82, 95% CI 0.72–0.92). An angiographic relationship with the OA was observed in 26 MMAs (19%). Conclusion In the majority of CSDH patients both anterior and posterior branches of the MMA should be targeted to achieve extensive convexity devascularization. Frequent anatomical variations of the MMA with respect to emergence of the posterior branch and MMA orbital branches are expected to impact CSDH embolization strategy.Keywords
This publication has 30 references indexed in Scilit:
- Risks of presurgical embolization of feeding arteries in 137 intracranial meningeal tumorsActa Neurochirurgica, 2013
- Facial paralysis after superselective intra-arterial chemotherapy via the middle meningeal artery in maxillary cancerAuris Nasus Larynx, 2009
- Developmental Anatomy, Angiography, and Clinical Implications of Orbital Arterial Variations Involving the Stapedial ArteryNeuroimaging Clinics of North America, 2009
- Landmark-Based Analysis of the Morphological Relationship Between Endocranial Shape and Traces of the Middle Meningeal VesselsThe Anatomical Record, 2009
- Arterial Vascularization of the Cranial NervesNeuroimaging Clinics of North America, 2008
- BLOOD SUPPLY OF THE FACIAL NERVE IN THE MIDDLE FOSSAOperative Neurosurgery, 2008
- Outcome Analysis of Preoperative Embolization in Cranial Base SurgeryActa Neurochirurgica, 2002
- Chronic Subdural Hematoma in Elderly People: Present Status on Awaji Island and Epidemiological ProspectNeurologia medico-chirurgica, 1992
- Ischemic paralysis of the facial nerve: A possible etiologic factor in Bell's palsyThe Laryngoscope, 1976
- Epidemiology of chronic subdural haematomaActa Neurochirurgica, 1975