Anterior ethmoidal artery: microsurgical anatomy and technical considerations

Area of Science:

• Neurosurgery
• Vascular Anatomy
• Cranial Base Surgery

Background:

• Vascular lesions in the anterior cranial fossa often receive substantial blood supply from the anterior ethmoidal artery.
• Embolization of this artery risks ophthalmic artery complications, potentially causing vision loss.
• Understanding microsurgical anatomy is crucial for safe proximal control of these feeders.

Observation:

• Eight cadaveric dissections revealed the anterior ethmoidal artery's course from the ophthalmic artery to the cribriform plate.
• Two clinical cases demonstrated the artery's feeders in meningioma and arteriovenous malformation resections.
• The artery was identified and controlled at the anterior ethmoidal foramen and cribriform plate.

Findings:

• The anterior ethmoidal artery presents three critical surgical access points: the anterior ethmoidal foramen, the anterior ethmoid canal, and extradurally at the cribriform plate.
• These sites are optimally accessed via a fronto-orbital single-flap craniotomy.
• This approach allows for early proximal control of anterior ethmoidal artery feeders.

Implications:

• The fronto-orbital single-flap craniotomy offers a valuable alternative for managing complex anterior cranial fossa vascular lesions.
• This technique enhances surgical safety by enabling precise control of the anterior ethmoidal artery.
• The study provides anatomical insights for neurosurgeons dealing with challenging vascular pathologies in this region.