Introduction: The middle meningeal artery (MMA) represents the most common source of acute traumatic epidural hematoma. The identification of the relationship between the MMA and the surface of the skull is paramount for a variety of surgical approaches of anterior and middle cranial fossa pathologies.
Methods: 10 adult cadavers (20 sides) underwent dissection of the MMA to study its relationship to surface anatomic structures. Since the pterion overlies the anterior branch of the MMA, it was identified and subdivided into four sectoinss: sphenoparietal, frontotemporal, stellate, and epipteric. We measured the distance to the center of the pterion from several superficial structures such as the superior border of the zygomatic arch and the posterolateral margin of the frontozygomatic suture. We also measured the distance to the anterior branch of the MMA from several external structures such as the superior border of the zygomatic arch and the center of the pterion. The exposed surgical targets were also evaluated with a neuronavigation instrument. Anatomical and neuronavigation correspondence was subsequently validated.
Results: The location of the anterior branch of the MMA was relatively constant on both sides. We also found a constant relation of the pterion to the anterior branch of the MMA, and of the center of the pterion to the zygomatic arch and to the frontozygomatic suture. The relationship between the superior border of the zygomatic arch and the anterior branch of the MMA was also evaluated.
Conclusions: The MMA runs just underneath the skull and is intimately associated with the dura mater just beneath the pterion. In addition to being the most common source of acute traumatic epidural hematoma, it can also be easily damaged perioperatively. The thorough analysis of the regional anatomy allowed us to identify reliable landmarks to locate the position of the MMA at the level of the foramen spinosum and at its more distal course. Perfect knowledge of the course of the artery allows for a safer surgical dissection.
Patient Care: By improving knowledge of surgical anatomy, we help to reduce patient morbidity and mortality.
Learning Objectives: By the conclusion of this session, participants should be able to identify external landmarks for the middle meningeal artery.