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An additional variant of the persistent primitive trigeminal artery: accessory meningeal artery--antero-superior cerebellar artery anastomosis associated with moyamoya disease.

Persistent embryological carotid-basilar anastomoses are rare. There has been no report on persistent anastomosis between the accessory meningeal artery and the antero-superior cerebellar artery. We describe a 3-year-old boy with moyamoya disease manifesting such a congenital vascular anomaly, namely, a large anastomosis between the accessory meningeal artery and the antero-superior cerebellar artery associated with marked hypoplasia of the basilar artery. This persistent vascular anomaly is considered embryologically as an additional variant of the persistent primitive trigeminal artery, i.e., a "stapedo-trigemino-cerebellar" variant.

Basilar Artery↗

Meningeal arterial patterns in great apes: implications for hominid vascular evolution.

Arterial meningeal patterns were observed for 100 hemispheres from great ape endocasts (Pan paniscus, Pan troglodytes, Gorilla gorilla, and Pongo pygmaeus). Eight patterns emerged based on the relative contributions to the walls and dura mater of the middle part of the braincase of meningeal arteries that stem from two sources. These arteries enter the braincase through either the orbit (delivering blood from the internal carotid artery) or through the base of the middle cranial fossa (via the middle meningeal artery whose blood comes from the external carotid artery). The three genera of apes manifest different frequencies of the eight patterns, with orangutans highly dependent on orbital meningeal arteries at one extreme, and chimpanzees showing the greatest reliance on the middle meningeal artery at the other. As was the case in an earlier study of rhesus monkeys, there is a trend across the two genera of African apes for increased mean cranial capacity to be associated with increased reliance on the internal carotid artery for supplying the middle portion of the braincase. However, unlike the case for macaques, this trend does not reach statistical significance in African apes. Because it is rare for humans to manifest significant arterial contributions from the orbit to the middle cranial fossa, the comparative data on monkeys, apes, and humans suggest that, during the course of vascular evolution in Homo, the middle meningeal artery eventually took over supply of the entire middle cranial fossa. This hypothesis should be tested in the hominid fossil record. Earlier work on meningeal arterial patterns in apes has traditionally relied on Adachi's system that was determined from humans and focuses on the origin of the middle branch of the middle meningeal artery. As a result, the extensive orbital contributions to the middle portion of the braincase that characterize apes were not recognized and the eight patterns described in this paper were often erroneously assigned to the three patterns that adequately describe only humans. Adachi's system should therefore be abandoned for nonhuman primates and early hominids. A correct understanding of meningeal arterial evolution cannot be achieved until the orbital contributions to the meningeal arteries are recognized and incorporated into an evolutionary study that spans from apes to fossil hominids to living people.

Animals↗

A histological, ultrastructural and immunohistochemical study of superficial temporal arteries and middle meningeal arteries in moyamoya disease.

Pathologic changes in superficial temporal arteries (STA) and middle meningeal arteries (MMA) biopsied from 15 patients with moyamoya disease (MD) who had undergone cerebro-temporal arterio-synangiosis were studied histologically, ultrastructurally and immunohistochemically. The main pathologic features were: proliferation of smooth muscle cells (SMCs) and thickening of the intima, degeneration and destruction of SMCs in the media and intima, and the presence of condensed organelles in necrosed SMCs or the interstitium among SMCs, or both outside and within the elastica interna (EI). The EI had become thin, porous, fragmented and was even absent in some segments. These changes are different from those of other forms of angiopathy, but identical with those at the ends of internal carotid arteries (ICA) reported by us previously, being pathognomonic for MD. These changes in the STA and MMA reveal that MD involves not only the ICA but also the intra- and extracranial branches of external carotid arteries. The medial necrosis of SMCs seems to be the primary injury of the arterial wall in MD. STA tissue blocks from two cases of MD were stained immunohistochemically. By electron microscopy, IgG-, IgM-, and C3-positive granules were observed on the ER of endothelial and intimal cells. Further studies on more cases are needed to determine whether an immunoreaction has occurred in these arteries.

Adolescent↗

Dural caroticocavernous fistula with both ophthalmic arteries arising from middle meningeal arteries.

A 60-year-old woman presented with a dural caroticocavernous fistula (CCF) in whom both by ophthalmic arteries arose from the middle meningeal arteries instead of from the internal carotid arteries. Transarterial embolisation of the CCF was contraindicated because of the risk of blindness. Transvenous coil embolisation was therefore performed. Bilateral origin of the ophthalmic artery from the middle meningeal artery is extremely rare.

Brain Diseases↗

Accessory meningeal artery.

The accessory meningeal artery, originating from either the internal maxillary or middle meningeal artery, is predominantly an extracranial vessel. A minor branch of the artery enters the skull through the foramen ovale to supply the dura of the temporal fossa as well as the Gasserian ganglion. This intracranial branch may be demonstrated on angiography and may serve as a collateral between the external and the internal carotid arteries, with or without a complex intervening vascular network. The accessory meningeal artery may be identified as the arterial pedicle responsible for blood supply to meningiomas of the temporal fossa and possibly even to tumors of the Gasserian ganglion.

Carotid Artery Thrombosis↗

Radiographic anatomy of the accessory meningeal artery.

The accessory meningeal artery (AMA) was studied in 6 cadavers and correlated with the angiographic findings in 50 normal patients. The AMA is easily identified angiographically, its origin varying with the course of the internal maxillary artery. The authors believe that all intracranial lesions which are not strictly intracerebral should be investigated by means of selective injection of the internal maxillary artery.

Angiography↗

An anomalous ophthalmic artery arising from the middle meningeal artery.

A case of the left ophthalmic artery arising from the frontal branch of the middle meningeal artery was found in the cadaver of a 65 year-old Japanese man who died of senility. The original ophthalmic artery, much smaller than normal, arose from the internal carotid artery and communicated with a branch of the anomalous ophthalmic artery under the optic nerve. From this communicating branch, the central artery of the retina originated. The right ophthalmic artery was also anomalous. Though normal in origin and ramification, it passed under the optic nerve to reach the medial wall of the orbit.

Aged↗

Chemotactic activity and IL-8 levels in the cerebrospinal fluid in canine steroid responsive meningitis-arteriitis.

Steroid responsive meningitis-arteriitis (SRMA) is a systemic immune disorder, characterized by inflammatory-stenosing lesions of the meningeal arteries and meningitis. The predilection of the disease for the central nervous system (CNS) remains unexplained. In this study, chemotactic activity and chemotactic factors were measured in the cerebrospinal fluid (CSF) of dogs with SRMA. CSF of dogs with SRMA exerted a marked chemotactic activity for leukocytes. Neutrophils were attracted to a similar degree as by CSF from animals with bacterial encephalitis. Chemotactic activity was also noted for mononuclear cells, however, by far weaker than in CSF from animals with viral encephalitis. While the inflammatory process could be suppressed with glucocorticoid treatment, the chemotactic activity of CSF persisted. We could identify IL-8-like activities using a desensitization assay in the CSF of animals with SRMA and also found increased IgA levels. Increased chemotactic activity for polymorphonuclear leukocytes correlated positively with the levels of IL-8-like activity in CSF. Our observations clearly suggest that in SRMA chemotactic factors are generated in the CNS. These include IL-8, but probably also others. The intensity of this production appears to correlate with IgA levels in the CSF suggesting either a causal link or reflecting the severity of the inflammation.

Animals↗

Accessory meningeal artery: an anatomic misnomer.

The accessory meningeal artery is misnamed in view of the territory the artery supplies. The name implies that the vessel is an important addition to the middle meningeal artery in supplying the meninges. This is incorrect, because no more than approximately 10% of the blood flow of the accessory meningeal artery reaches the intracranial territory; 90% of the blood is carried to the extracranial structures. After reviewing the anatomy of the accessory meningeal artery we support the notion that the proper name of the vessel should be arteria pterygomeningica, or pterygomeningeal artery.

Arteries↗

Extracranial branches of the middle meningeal artery.

We present a case of unusual extracranial branches of the middle meningeal artery. The middle meningeal artery originated from the medial side of the maxillary artery and entered the skull through the foramen spinosum. The posterior superior alveolar artery originated from the middle meningeal artery, gave rise to the pterygoid branch, and entered the maxilla. In addition, the bifurcation of the common carotid artery was at the level of the second cervical vertebra. The embryogenesis of such rare branching pattern of the middle meningeal artery is not clear, but the anatomical consequences may have clinical implications.

Aged↗

[Subarachnoid hemorrhage and intracerebral hematoma in injury of the middle meningeal artery (aneurysma spurium)].

Traumatic lesions of meningeal arteries represent the typical cause of the acute epidural hematoma. Under certain circumstances, however, they may be the origin of space-occupying hemorrhages with only an intradural extent, e.g. subdural or intracerebral hematomas. We present a case of a temporal lobe hematoma with an additional subarachnoid hemorrhage. This gave rise to the suspicion of a spontaneously ruptured cerebral aneurysm that might have caused the patient's accident. Preceding the evacuation of the hematoma, cerebral angiography ruled out the suspected vascular malformation, but revealed a pseudoaneurysm of the middle meningeal artery close to a skull fracture. Intraoperatively, this lesion proved to be the source of the bleeding which was exclusively directed towards the intradural space. Presented is a review of the relevant literature regarding atypical hematomas secondary to meningeal artery lesions and traumatic aneurysms of these vessels.

Adult↗

Meningeal arteries in rhesus macaques (Macaca mulatta): implications for vascular evolution in anthropoids.

The branching patterns of meningeal arteries are reported for 200 endocast hemispheres representing rhesus monkeys (Macaca mulatta) of known cranial capacity. We detect five basic patterns for the branching of the anterior division of the middle meningeal artery and its relationship with the anterior meningeal artery. These results confirm and elaborate trends published for much smaller samples that were based on direct dissections of rhesus monkey arterial patterns. The most common pattern is that in which the anterior meningeal artery dominates the blood supply above the rostral part of the middle cranial fossa. Analysis of cranial capacities reveals that presence of this pattern on both sides of endocasts is associated with increased cranial capacity. When studied in light of published reports of anatomical dissections of cranial arteries in apes and human embryological data, the anterior meningeal artery in rhesus monkeys appears to be a possible homologue of the lacrimal meningeal artery in apes and the anterior branch of the middle meningeal artery in humans. This finding provides a step towards understanding cranial vasculature homologies that may be useful for accurately scoring the branching patterns of the meningeal arteries in monkeys, apes, and humans.

Animals↗