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Classification of the extracranial middle meningeal artery: a human dry skull, dissection and 3D CTA study
Hegong Wang1,2, Shangpeng Cheng1, Chongjun Xu1,2
1Tarim University School of Medicine, Alaer, China.
Abstract:
Unexpected treatment failures can occur during middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematoma cases. This study aimed to classify variations in the anatomy of the extracranial MMA (exMMA) to improve MMAE. Five heads from body donors, 300 dry skulls, and 162 head and neck CT angiography (CTA) images were used to evaluate the overall features of the exMMA. Body donors dissection were incorporated to comprehensive exMMA representation. The distal features of the exMMA were determined by evaluating the outer osseous grooves of the foramen spinosum of the skulls. Measurements of the exMMA were performed using CTA. The angles between the maxillary artery and the exMMA were 109.5° ± 32.5° (left) and 117.1° ± 34.3° (right) (p < 0.05). The angle between the exMMA and the skull base was greater on the left side (79.24° ± 4.21°, p = 0.0017). The diameters of the exMMA were 1.45 ± 0.12 mm (left) and 1.44 ± 0.13 mm (right) (p = 0.82). Multiple types of accessorial foramen spinosum provided the paths for the accessorial MMA. In the new classification, five types were identified. Type A was the most common (73.15%) and represented an easily accessible MMAE type. This was followed by type C (25.62%, difficult to accessible), type D (18.83%, very difficult to accessible), type B (1.23%, fairly accessible), and type E (0.17%, inaccessible). Varying levels of interventional difficulty occur within the exMMAs classification. Careful preoperative evaluations should be performed before MMAE to determine the type of exMMA and potential interventional difficulty.
Insights
This study classified extracranial middle meningeal artery (exMMA) anatomy to improve middle meningeal artery embolization (MMAE) success for chronic subdural hematoma. A new classification identified five types, with Type A being most common and accessible, while others presented varying degrees of difficulty.
Area of Science:
- Anatomy
- Interventional Radiology
- Neurosurgery
Background:
- Chronic subdural hematoma treatment can involve middle meningeal artery embolization (MMAE).
- Unexpected treatment failures during MMAE can occur due to anatomical variations of the extracranial middle meningeal artery (exMMA).
- A detailed classification of exMMA anatomy is needed to optimize MMAE procedures.
Purpose of the Study:
- To classify anatomical variations of the extracranial middle meningeal artery (exMMA).
- To improve the success rates of middle meningeal artery embolization (MMAE) for chronic subdural hematoma treatment.
- To correlate exMMA anatomical types with interventional difficulty.
Main Methods:
- Analysis of five body donor heads, 300 dry skulls, and 162 head and neck CT angiography (CTA) datasets.
- Dissections of body donors for comprehensive exMMA representation.
- Evaluation of distal exMMA features via osseous grooves of the foramen spinosum and CTA measurements.
Main Results:
- A new classification system for exMMA anatomy was developed, identifying five types (A-E).
- Type A was the most prevalent (73.15%) and considered easily accessible for MMAE.
- Other types presented varying accessibility: Type C (25.62%, difficult), Type D (18.83%, very difficult), Type B (1.23%, fairly accessible), and Type E (0.17%, inaccessible).
- Significant differences in angles between the maxillary artery and exMMA, and between exMMA and the skull base were noted between sides.
Conclusions:
- The classification of extracranial middle meningeal artery anatomy reveals significant variations.
- These anatomical variations directly correlate with the interventional difficulty of performing middle meningeal artery embolization.
- Preoperative evaluation of exMMA type is crucial for anticipating and managing potential interventional challenges in MMAE procedures.
