Recurrent ophthalmic arteries supplying posterior meningiomas: embryologic background and 3D anatomical visualization

Recurrent branches of the ophthalmic artery rarely function as feeding arteries to posteriorly located meningiomas. This study describes two such cases and examines the embryologic basis and collateral pathways that enable this atypical supply. The utility of three-dimensional (3D) simulation for delineating skull base vascular relationships is also assessed.

Two patients with posteriorly located meningiomas supplied by recurrent ophthalmic artery branches underwent detailed angiographic evaluation. The embryogenesis of the superficial recurrent ophthalmic artery (SROA) and deep recurrent ophthalmic artery (DROA) was reviewed based on established developmental models. Contrast-enhanced MRI, rotational angiography, and MRI CISS sequences were fused using GRID software to visualize vascular courses relative to the cerebellar tentorium and cranial nerves.

In both tumors, the SROA or DROA continued distally as tentorial arteries and contributed to tumor vascularization. Fusion 3D simulation enabled clear visualization of these recurrent branches, their tentorial trajectories, and their anatomical relationships with the surrounding dura and cranial nerves. These findings demonstrate that persistent embryologic communications between the ophthalmic artery and adjacent ICA dural branches may supply lesions far from the orbit.

Recurrent ophthalmic artery branches can function as feeding vessels to posterior meningiomas through embryologically derived anastomotic pathways. Integrating 3D simulation into preoperative hemodynamic assessment enhances understanding of such vascular variants and supports safer treatment planning.