Different ophthalmic artery origins: Embryology and clinical significance

Abstract

This retrospective study gives a summary of ophthalmic artery (OA) variations to serve as guidelines for surgical interventionists and trainees. Pubmed and Medline searches were conducted. The OA usually arises intradurally (superomedial, anteromedial, or rarely superolateral) from the internal carotid artery (ICA). Rare extradural origin (primitive dorsal OA) (PDOA) remnant and extremely rare interdural origin (primitive ventral OA) (PVOA) remnant are of significance when sectioning the dural ring. Rarely, a persistent PDOA with ICA origin, or a PDOA remnant with inferolateral trunk origin, enters the orbit via the superior orbital fissure (SOF) for sole or partial orbital supply. Extremely rare, the PDOA and PVOA persist and form double OAs that arise from the ICA and run via the SOF and optic foramen. Occasionally, the OA arises from the middle meningeal artery (MMA), when both the PDOA and VDOA regress and enter the orbit via the SOF. Sole orbital supply via the external carotid artery (ECA), i.e. meningo-ophthalmic artery and/or MMA branches, or dual OAs (ECA and ICA origins) may occur. Other rare OA origins include anterior or posterior communicating artery; anterior or middle cerebral artery; basilar artery; posterior inferior cerebellar artery; and the carotid bifurcation. Primitive arteries (persistent or remnant), and/or abnormal anastomoses play pivotal roles in manifestations of OA variations. Of clinical importance are orbital collateral routes and dangerous extracranial-intracranial anastomoses. Awareness of OA origins and collateral routes is imperative for transarterial embolizations or infusion chemotherapy in the ECA territory to prevent visual complications.

Anatomy of the Ophthalmic Artery: A Review concerning Its Modern Surgical and Clinical Applications

“…According to Hayreh and Dass [ 4 ], in 83.6% of the cases it arises above dura and follows an intradural course, in 6.6% of the cases it arises just above dura, and at 10% it arises below dura and follows a totally or partially extra dural course. Other researchers [ 7 , 12 , 13 ] have published similar results. OA originates from superomedial wall of ICA in 40% of the cases, anteromedial wall in 51%, medial wall in 6%, and superior wall in only 3% of the cases [ 4 ].…”

“…OA originates from superomedial wall of ICA in 40% of the cases, anteromedial wall in 51%, medial wall in 6%, and superior wall in only 3% of the cases [ 4 ]. Those numbers are not universally accepted as other researchers have found different percentages [ 7 , 10 , 13 ].…”

“…Connection between MMA and OA persists even after translocation of MMA as an External Carotid Artery (ECA) branch at adult life through a developed and clinically important anastomosis between those two systems or as many minute anastomoses. Finally, at 40 mm embryo, adult pattern is established and identified [ 13 – 16 ]. Notably, ECA contribution to the eye diminishes as we ascend evolution tree [ 5 , 14 ] ( Figure 1 ).…”

Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply

“…A serious potential complication of preoperative meningioma embolization is blindness due to inadvertent central retinal artery (CRA) ischemia, caused by anomalous origin of the ophthalmic artery (OA) arising from the MMA. One study reported a 1.45% incidence of OA origin from the MMA stem or its branches, entering the orbit via the superior orbital fissure instead of the optic canal, among 1652 patients 28. This meningo-ophthalmic artery anomaly has several variants, including a single OA arising from the MMA, dual OAs with ICA and MMA origins, and the MMA arising from the OA.…”

Intra‐arterial Modulation of the Trigeminal Nerve Ganglion in Patients with Refractory Trigeminal Neuralgia

“…The trigeminal‐cardiac reflex from the stimulation of sensory branches of the trigeminal nerve has been reported with embolization of the middle meningeal artery and may represent a direct effect of intra‐arterial injection of dimethyl sulfoxide/ethylene‐vinyl alcohol copolymer . Resolution of trigeminal neuralgia associated with arterio‐venous malformations has been reported following embolization of the middle meningeal artery at the foramen rotundum …”