Persistent Basilar/Middle Meningeal Artery Anastomosis

Abstract

Three cases of a basilar/middle meningeal artery anastomosis are demonstrated angiographically. No reference to previous angiographic demonstration of this vascular anomaly has been found in the literature, and only one similar case with an anatomical description has been located. An embryological explanation of this rare anastomosis is presented.

Basilar-middle meningeal artery anastomoses associated with a cerebral aneurysm

“…of the internal carotid artery via a persistent stapedial artery. 1,5,8 The ipsilateral foramen spinosum was absent radiographically in one of Seeger and H e m m e r ' s cases and in the autopsy study by Altmann. The appearance of the foramina spinosa in the current case was not noted.…”

“…, 9,12 The angiographic appearance of unilateral BA-M M A anastomosis has been described in five patients. 3,8,11 The anomalous anastomotic vessel always originated from the basilar artery several millimeters proximal to the SCA. Altmann ~ described an abnormal vessel in a 7-month-old fetus, termed the "acoustico-facial artery," which arose from the basilar artery between the anterior and posterior inferior cerebellar arteries.…”

Anomalous Origin of the Middle Meningeal Artery from the Posterior Inferior Cerebellar Artery

“…Various sources of anomalous origin of the MMA have been reported in the literature (Table 1). 3–12 Some authors have described the anomalous origin of the MMA from the basilar artery 2–6 . The very first case of MMA origin from basilar artery was reported by Altman in 1947 during the postmortem dissection of a 7‐month old fetus 2 .…”

“…The very first case of MMA origin from basilar artery was reported by Altman in 1947 during the postmortem dissection of a 7‐month old fetus 2 . After the aforementioned anatomical description, Seeger and Hemmer, in 1976, described 3 patients with the first angiographic evidence of left MMA origin from the basilar artery 3 . Waga et al reported a single case of basilar‐MMA anastomosis in a 47‐year‐old man during angiography.…”

“…The middle meningeal artery (MMA) is the largest branch of the internal maxillary artery supplying the meninges. Some reported aberrant sources include origin from the third part of the maxillary artery, persistent stapedial artery, ophthalmic artery, internal carotid artery, ascending pharyngeal artery, basilar artery, and lacrimal artery 1–6 . The variations in the origin of the MMA are of clinical importance while dealing with fractures of the base of the skull, epidural hematomas, surgery of the nerve of the pterygoid canal or the Vidian nerve, and during endovascular and surgical interventions of the internal maxillary artery.…”