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CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0045-1813021
Clinical Images

Middle Meningeal Artery Originating from the Basilar Artery: Neuroimage

Authors

  • Lívio Pereira de Macêdo 

    1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
    2   Department of Interventional Neuroradiology, Hospital da Restauração, Recife, Pernambuco, Brazil
    3   Department of Neurointerventional Radiology, ANGIORAD, Recife-PE, Brazil

  • Pedro Sobral Barbosa da Silva 

    4   Faculdade Pernambucana de Saúde, Recife, Pernambuco, Brazil

  • Francisco Ranilson Alves Silva 

    2   Department of Interventional Neuroradiology, Hospital da Restauração, Recife, Pernambuco, Brazil

  • Ítalo Emmanuel Lima Ferreira 

    2   Department of Interventional Neuroradiology, Hospital da Restauração, Recife, Pernambuco, Brazil

  • Marcos Antônio Barbosa da Silva 

    2   Department of Interventional Neuroradiology, Hospital da Restauração, Recife, Pernambuco, Brazil

  • Eduardo Vieira de Carvalho-Junior

    1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil

  • José Laércio Júnior Silva 

    1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
    2   Department of Interventional Neuroradiology, Hospital da Restauração, Recife, Pernambuco, Brazil
    3   Department of Neurointerventional Radiology, ANGIORAD, Recife-PE, Brazil

  • Hildo Rocha Cirne Azevedo-Filho 

    1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
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Abstract

The middle meningeal artery (MMA) supplies over two-thirds of the cranial dura mater, making its anatomical knowledge crucial for surgery. Rarely, the MMA may originate from the basilar artery. Typically, it arises between the superior cerebellar artery and anterior inferior cerebellar artery, following a course near the trigeminal nerve to reach the petrous branch of the MMA. An embryological origin involves anastomosis between persistent stapedial and trigeminal arteries. The image illustrates an unusual case of a patient with right MMA originating from the posterior circulation via the basilar artery.


Keywords

angiogram - medial meningeal artery - neurosurgery - neurovascular anatomy variation - vascular anatomy

The middle meningeal artery (MMA) plays a vital role in supplying over two-thirds of the cranial dura mater, making a comprehensive understanding of its vascular anatomy essential for neurosurgeons and interventional neuroradiologists. Typically, the MMA originates from the maxillary artery, a branch of the external carotid system. However, rare anatomical variants have been reported, including origins directly from the basilar artery. This anatomical variation is extraordinarily uncommon and has significant clinical and surgical implications.[1] [2]

The first documented cases of MMA arising from the basilar artery were described by Altmann, who highlighted instances where the vessel arises directly from the posterior circulation rather than its usual external carotid source.[3] Such variations are rare, with only a few case reports documented in recent literature.[4] [5] [6] [7] [8]

Embryologically, this variation is believed to result from persistent anastomoses between the stapedial artery and trigeminal artery systems.[4] [5] Normally, these embryonic channels regress; however, in rare cases, they persist, leading to abnormal vascular pathways, including direct branches from the basilar artery supplying areas typically perfused by external carotid branches.[9] Recent studies suggest that these anomalies result from incomplete regression of embryonic arteries, creating persistent connections between the posterior circulation and extracranial vessels.[10]

The clinical importance of recognizing these variants is essential. Unanticipated vascular anatomy can significantly increase the risk of intraoperative hemorrhage, inadvertent vessel injury, or incomplete embolization in neurointerventional procedures. For instance, during embolization of tumors, arteriovenous malformations (AVMs), or skull base surgeries, unexpected origins of the MMA from the basilar artery may lead to misjudged vascular territories, thereby elevating the risk of complications. Advances in imaging, particularly high-resolution computed tomography angiography and digital subtraction angiography (DSA), have greatly enhanced the detection of these anomalies, enabling meticulous surgical planning and risk mitigation.[11] [12] [13]

Epidemiologically, data on this variation remain limited due to its rarity. Most reports are isolated case report, with an estimated incidence of less than 0.1% among patients undergoing DSA. Although rare, this prevalence highlights the importance for clinicians to maintain vigilance, especially when operating in regions involving the skull base, posterior fossa, or posterior circulation.

The images discussed showcase a unique case where the right MMA arises directly from the basilar artery ([Figs. 1] and [2]), discovered during DSA performed for surgical planning of a left temporoparietal pial AVM. Notably, this variant did not contribute to the AVM's blood supply. Its identification was primarily of diagnostic importance due to its rarity, and it did not alter the surgical approach. Nonetheless, this case emphasizes the importance of thorough angiographic assessment and awareness of potential vascular anomalies. Proper documentation of such variant aids in tailoring surgical strategies, minimizing risks, and it contributes to the growing body of knowledge on cerebrovascular anatomy.

Zoom
Fig. 1 Lateral view of a cerebral angiogram. The white arrow indicating the origin of the right middle meningeal artery (MMA) from the basilar artery.
Zoom
Fig. 2 Anteroposterior view of a cerebral angiogram. The white arrow indicating the origin of the right middle meningeal artery (MMA) from the basilar artery.

In conclusion, although the origin of the MMA from the basilar artery is exceedingly rare, identifying this variant is critical for safe surgical practice. Advances in imaging technology facilitate its detection, fostering better tailored interventions, and ultimately improving patient outcomes.


Conflict of Interest

None declared.


Address for correspondence

Lívio Pereira de Macêdo, MSc
Rua Nogueira de Souza, 326, Pina, Recife, PE, 51110-110
Brasil   

Publication History

Article published online:
19 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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Zoom
Fig. 1 Lateral view of a cerebral angiogram. The white arrow indicating the origin of the right middle meningeal artery (MMA) from the basilar artery.
Zoom
Fig. 2 Anteroposterior view of a cerebral angiogram. The white arrow indicating the origin of the right middle meningeal artery (MMA) from the basilar artery.