Pterion: Morphometry and Surgical Significance

Introduction: Pterion is a H-Shaped formation of sutures and cranio-metric point on the lateral side of skull. It is marked by the junction of frontal, parietal, greater wing of sphenoid & squamous temporal bone. Objective: The study is aimed to determine prevalence of types of pterions, presence of epipteric bone. We also tried to find pterion’s relationship with anterior branch of middle meningeal artery Materials and methods: Study was done in department of Anatomy, GMCH-32, Chandigarh on 40 adult dried skulls without calvaria, of unknown age, gender and race. The skulls with broken lateral wall were excluded. Skulls were examined for 1. A. prevalence of pterion shape B. Prevalence of bilaterality of similar shape of pterion. C. Prevalence of unilateral variation of pterion on two sides of skull. 2. Epipteric bone A. Presence of epipteric bone B. relation to the suture on both sides. 3. Distance of pterion center point to frontozygomatic suture and upper border of zygomatic arch. 4. relationship of pterion on external and internal surface of skull and on inner side its relationship with anterior branch of Middle meningeal artery. Observations: In the present study 3 types of pterions i.e., Sphenoparietal, stellate, frontotemporal were observed. Sphenoparietal was found to be present bilaterally 40% on both sides. Frontotemporal & stellate were 2.5%. Sphenoparietal type of pterion was 55% on right side & 67.5% on left side. frontotemporal type of pterion was 5% on right side & 2.5% on left side, stellate type was 7.5% on right side & 2.5% on left side. epipteric bone were present in pterion on right side in 32.5% & on left side 27.5%. Pterion was lying approximately 3.5 cm above the zygomatic arch and 2.83 cm behind the posterior margin of frontozygomatic suture. Conclusion: in our study the commonest type of pterion shape was Sphenoparietal. This type was most common to be present bilaterally. Epipteric bone was found in Sphenoparietal type both unilaterally & bilaterally. The anterior branch of MMA was closest and farthest in stellate type.

Comparison of the efficacy of middle meningeal artery embolization and conventional therapy for chronic subdural hematomas: a propensity score matching study / 中华放射学杂志

Objective:To compare the effect of middle meningeal artery embolization (MMAE) versus conventional therapy for chronic subdural hematoma (CSDH).Methods:Retrospective analysis of 38 patients with 48 CSDHs treated with MMAE from May 2019 to May 2021 was performed. Comparisons were made with a conventional treatment for 126 patients with 126 CSDHs from January 2016 to May 2021. The MMAE and conventional treatment patients were matched by the propensity score matching method, and a total of 25 pairs of patients (31 pairs of CSDHs) were successfully matched. The CSDH recurrence, rescue treatment, radiographic follow-up outcome, clinical improvement and complication between the two groups were compared by t test, χ 2 test or Fisher exact probability methods. Results:The rescue treatment rate in MMAE group was significantly lower than that in conventional treatment group [0 (0/31) vs 19.4% (6/31), P=0.024] and the complete resolution rate at 6 months follow-up in MMAE group was significantly higher than that in conventional treatment group [96.8 (30/31) vs 74.2% (23/31), P=0.026]. In terms of CSDH recurrence, there was a trend of lower recurrence in the MMAE group [3.2%(1/31) vs 22.6% (7/31), P=0.053]. The complete resolution rate at 3 months follow-up was 61.3% (19/31) in MMAE group and 45.2% (14/31) in conventional treatment, clinical improvement rate was 92.0% (23/25) in MMAE group and 88.0% (22/23) in conventional treatment, good outcome rate (mRS≤2) was 92.0% (23/25) in MMAE group and 84.0% (21/25) in conventional treatment, complication rate was 0(0/25) in MMAE group and 4.0% (1/25) in conventional treatment, and there were no significant differences in all above-mentioned parameters ( P>0.05). Conclusions:The MMAE may be considered as a safe and effective treatment for CSDH, and MMAE for CSDH is associated with lower trend of recurrence, lower rescue treatment rate and better radiographic follow-up outcome than conventional therapy.

Anatomy of the Middle Meningeal Artery

Introduction The middle meningeal artery (MMA) is an important artery in neurosurgery. As the largest branch of the maxillary artery, it provides nutrition to the meninges and to the frontal and parietal regions. Diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (TAVF), Moya-Moya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine, and meningioma,may be related to the MMA. The aim of the present study is to describe the anatomy of the MMA and to correlate it with brain diseases. Methods A literature review was performed using the PubMed, Scielo, Scientific Direct, Ebsco, LILACS, TripDataBase and Cochrane databases, with the following descriptors: neurosurgery, neuroanatomy, meninges and blood supply. Discussion The MMA is embedded in a cranial groove, and traumatic or iatrogenic factors can result in MMA-associated pseudoaneurysms or arteriovenous fistulas (AVFs). In hemodynamic stress, true aneurysms can develop. Arteriovenous fistulas, pseudoaneurysms, and true aneurysms can be effectively treated by endovascular or surgical removal. In MMD, the MMA plays a role in the development and in the improvement of collateral circulation. Finally, in cases of CSDH, when standard surgery and drainage fail, MMA embolization can constitute a great alternative. Conclusion The MMA is a relevant structure for the understanding of neurosurgical diseases. In conclusion, every neurosurgeon must know the anatomy of the MMA sufficiently to correlate it with the diagnosed pathology, thus obtaining treatment effectiveness and preventing brain lesion.

Bone bridges in the groove for middle meningeal artery / Puentes óseos en el surco para la arteria meníngea media

SUMMARY: The middle meningeal artery is an important vessel that is distributed in the endocranium region, between greater wing of sphenoid by the homonymous groove. There are few references on the formation of bone bridges in their trajectory, an aspect of relevance in morphology. The present study included 100 skulls -dried and whole heads- of adults, removing the calvaria, and identifying the spinous foramen, through which the middle meningeal artery courses to determine the existence or not of bone bridges -unilateral, bilateral or absence- for the passage of this artery. Of 100 adult skulls analyzed, it was found at the level of the medial aspect of the greater wing of the sphenoid bone and in its internal table, 73 % presented it and in 27 % there was absence. Of the specimens with bone bridges, 39 % were bilateral and of the latter, 34 % was unilateral and 16 % was on the right and 18 % on the left. The bony bridge for the middle meningeal artery is an anatomical constant that must be evaluated in anatomical, clinical and surgical considerations.

RESUMEN: La arteria meníngea media se distribuye en la región del endocráneo entre el ala mayor del esfenoides por el surco para dicha arteria. Existen pocas referencias sobre la formación de puentes óseos en su trayectoria, aspecto de relevancia en el campo morfológico. El presente estudio incluyó 100 cráneos -secos y cabezas enteras- de adultos, a los que se les extirpó la calvaria e identificó el foramen espinoso, por donde discurre la arteria meníngea media, para determinar la existencia o no de puentes óseos -unilaterales, bilaterales o ausenciaen su interior. De 100 cráneos adultos analizados, se encontró puentes óseos a nivel de la lámina medial del ala mayor del hueso esfenoides y en su tabla interna en un 73 % y en el 27 % no hubo. De las piezas con puentes óseos, el 39 % eran bilaterales y el 34 % eran unilaterales; el 16 % a la derecha y el 18 % a la izquierda. El puente óseo de la arteria meníngea media es una constante anatómica que debe ser evaluada en consideraciones anatómicas, clínicas y quirúrgicas.

Anatomical Variation of the Auriculotemporal Nerve in Thai Cadavers / Variación Anatómica del Nervio Auriculotemporal en Cadáveres Tailandeses

SUMMARY: The auriculotemporal nerve (ATN) is an important structure lying within a limited area of an infratemporal region (ITR). The ATN is originated from the posterior branch of the mandibular division of the trigeminal nerve (V3). The ATN conveys somatosensory, secretomotor, and parasympathetic fibres of the V3 and gustatory nerve (CN IX). In literature, the most common pattern of the ATN is composed of 2 roots that encloses the middle meningeal artery (MMA). However, in many studies, it has been reported that there are many variations in ATN pattern formation. To study the variation of ATN pattern formation in Thai cadavers, 73 hemifaces from 39 Thai embalmed cadavers were dissected and the relations of the ATN to the MMA were recorded. This study concluded that there were 4 patterns observed in Thai cadavers. The common pattern is 2 roots (67.1 %), 3 roots (15.1 %), 1 root (9.6 %), and 4 roots (8.2 %). Knowledge of this variation in the ATN may be useful in understanding the symptoms of temporo-orofacial pain, paresthesia of temporomandibular joint (TMJ), possible side effects from the TMJ surgery and the efficiency of auriculotemporal nerve block for regional anesthesia of the temporomandibular joint in Thai people.

RESUMEN: El nervio auriculotemporal (NAT) es una estructura importante que se encuentra dentro de la región infratemporal (ITR). El NAT se origina en la rama posterior de la división mandibular del nervio trigémino (V3), y transmite fibras somato sensoriales, secreto motoras y parasimpáticas del V3 y del nervio gustativo (CN IX). En la literatura, se reporta que el patrón más común de NAT está compuesto por 2 raíces que contienen la arteria meníngea media (AMM). Sin embargo, en diversos estudios, se ha informado que existen múltiples variaciones en la for- mación de patrones NAT. Con el objetivo de estudiar la variación de la formación del patrón NAT en cadáveres tailandeses, se disecaron 73 estructuras hemi faciales de 39 cadáveres tailandeses y se registraron las relaciones del NAT con el AMM. En conclusión, se observaron 4 patrones en los cadáveres tailandeses. El patrón común de 2 raíces (67,1 %), 3 raíces (15,1 %), 1 raíz (9,6 %) y 4 raíces (8,2 %). El conocimiento de esta variación en el NAT puede ser útil para comprender los síntomas de dolor temporo-orofacial, parestesia de la articulación temporomandibular (ATM), posibles efectos secundarios de la cirugía de ATM y la eficacia del bloqueo del nervio auriculo-temporal para la anestesia regional de la articulación temporomandibular en Tailandeses.

Middle meningeal vein dural arteriovenous fistula: A report of nine cases and literature review / 第二军医大学学报

Objective To summarize the clinical symptoms, imaging features and endovascular treatment outcomes of the middle meningeal vein dural arteriovenous fistula (MMV-DAVF). Methods The data of nine MMV-DAVF patients admitted to our hospital from Jan. 1999 to Apr. 2020 were retrospectively collected. A total of 16 Chinese and English articles, including 23 cases of MMV-DAVF, were retrieved from the database between Jan. 1, 1960 and Aug. 30, 2020. The clinical symptoms, imaging features and endovascular treatment outcomes were analyzed. Results Of the nine MMV-DAVF patients in our hospital, seven patients had a clear history of head trauma. Headache (five cases) and intracranial murmur (five cases) were the most common clinical symptoms. Six patients had computed tomography (CT) data, and four of them had skull fracture and five had intracranial hemorrhage. All the nine patients were drained from the middle meningeal vein (MMV) to adjacent venous sinus or venous plexus. The nine patients were treated with Onyx-18 glue endovascular intervention via middle meningeal artery (MMA) approach, and seven patients had complete embolization immediately after operation and two had subtotal embolization. No recurrence or new onset of DAVF was found in four patients having CT data half a year after operation. Among the 32 patients from our hospital and literatures, 26 patients (81.2%) had a clear history of head trauma, 16 patients (50.0%) suffered from headache, and 12 patients (37.5%) suffered from intracranial murmur. Twenty-five patients had CT data, including 21 patients (84.0%) with skull fracture, 16 patients (64.0%) with intracranial hematoma. Twenty patients (62.5%) were treated with endovascular interventional therapy via MMA approach, and 16 patients (80.0%) had complete embolization immediately after operation. Among them, seven cases had imaging follow-up data half a year after operation, and no recurrence or new onset of DAVF was found. Conclusion MMV-DAVF is rare, and many patients have head trauma history combined with skull fracture or intracranial hematoma. Endovascular embolization via MMA approach is safe and effective in treating MMV-DAVF.

Surgical importance of distance from mandibular condyle to carotid canal and foramen spinosum: an anatomical study

Background: The objective of this study was to compare the distance from mandibular condyle to internal carotid artery and middle meningeal artery.Methods: In this study 20 skulls obtained from the Department of Anatomy were utilized for the study. The following two parameters were measured using Vernier Caliper (digital). 1. Distance from Mandibular condyle to carotid canal 2. Distance from medial margin of Mandibular condyle to Foramen spinosum. All the measurements were taken thrice to minimize errors. Photograph of the skull base showing the measurements done was captured.Results: A total of 40 sides, 20 right and 20 left sides were studied. The mean distance between medial margin of mandibular condyle to carotid canal was 11.2 mm±0.6 on right side and 11.6mm±0.8 on left side. The mean distance from the medial margin of mandibular condyle to Foramen spinosum (middle meningeal artery) was 9.3 mm±1.1 on right side and 9.8mm±0.9 on left side. Conclusions: The distance between mandibular condyle to Middle meningeal artery is less compared to the distance between Mandibular condyle to carotid artery. The current study concludes that MMA is comparatively at high risk for damage compared to internal carotid artery.

Rupture of a Middle Meningeal Artery Pseudoaneurysm in Moyamoya Syndrome Related with Tuberculous Meningitis

We report a rare case of a patient with Moyamoya syndrome who presented with intracerebral hemorrhage resulting from rupture of a middle meningeal artery pseudoaneurysm. This 38-year-old woman was unconscious and hemiplegic when she was admitted to our hospital. The patient had mental retardation as a result of tuberculous meningitis infection at the age of one year. On radiologic examination, she had intracerebral hemorrhage in the right temporo-parietal lobe and an aneurysm in the middle meningeal artery with right internal carotid artery occlusion. The patient underwent surgical treatment for the hemorrhage and aneurysm. The radiologic data, intraoperative findings, and pathology were consistent with a diagnosis of pseudoaneurysm. In the current report, we describe a rare case of a patient with a history of tuberculous meningitis who developed Moyamoya syndrome and pseudoaneurysm, which resulted in a ruptured middle meningeal artery pseudoaneurysm and brain hemorrhage.

Unusual origin and relations of the accessory meningeal artery: a case report / Origen inusual y relaciones de la arteria meníngea accesoria: reporte de un caso

SUMMARY: Accessory meningeal artery is a branch of the first part of the maxillary artery. It supplies the structures in the infratemporal fossa and the dura mater in the middle cranial fossa. Accessory meningeal artery arose from the middle meningeal artery, 25 mm below the base of the skull and entered the middle cranial fossa through the foramen ovale. The two roots of the auriculotemporal nerve looped around it. The knowledge of the variant origin and relations may be useful during the surgeries of the infratemporal fossa. It might also be useful to the radiologists.

RESUMEN: La arteria meníngea media es una rama accesoria que emerge al inicio de la arteria maxilar. Suministra la vascularización a nivel de la fosa infratemporal y la duramadre en la fosa craneal media. En este trabajo, surgió una arteria meníngea accesoria de la arteria meníngea media, a una 25 mm por debajo de la base del cráneo, accediendo en la fosa craneal media a través del foramen oval. Las dos raíces del nervio auriculotemporal la rodeaban. El conocimiento de esta variación y sus relaciones pueden ser útiles durante las cirugías de la fosa infratemporal, como así también puede ser útil para los radiólogos.

Foramen meningo orbitario / Meningo orbital foramen

El foramen meningo orbitario (FMO), ubicado en el ala mayor del esfenoides y cercano al extremo lateral de la fisura orbitaria superior (FOS), comunica órbita con fosa craneal media, permitiendo el paso de una anastomosis entre las arterias oftálmica y meníngea media. Su prevalencia varía del 6 al 82,9 % y puede presentarse en forma unilateral o bilateral, único o múltiple y de forma circular, ovoidal o de ranura. Nuestro objetivo fue evidenciar la presencia del FMO, describiendo sus características morfológicas, en cráneos secos de individuos adultos chilenos de ambos sexos. Se utilizaron 54 cráneos con ambas órbitas. Se consideró; presencia, unilateralidad o bilateralidad, cantidad de forámenes por órbita, forma, ubicación en relación al plano horizontal determinado por el extremo lateral de la FOS, distancia al extremo lateral de la FOS, diámetro y diferencias sexuales. Las mediciones se realizaron con sonda de nylon, compás de puntas secas y cáliper digital. Un 46,29 % de la muestra presentó FMO, con mayor presencia en individuos femeninos. En un 28 % se presentó unilateral y en un 72 % bilateral. Predominó la forma circular (79,07 %) sobre la ovoidal (18 %) y sobre la forma de ranura (2,33 %). El FMO se observó en un 90,69 % sobre el plano horizontal que determina el extremo lateral de la FOS y en un 9,31 % en el mismo plano. La distancia del FMO al extremo lateral de la FOS fue de 6,58 mm y el diámetro del FMO correspondió a 1,22 mm. Nuestros resultados coinciden con la literatura, respecto a su presencia, a la comunicación que permite, a su ubicación, a su forma y tamaño. Se pudo constatar semejanzas y algunas diferencias menores con cráneos indios, asiáticos y pakistaníes. También pudimos evidenciar diferencias por sexo. El conocimiento acabado del FMO tiene importancia en anatomía, antropología, oftalmología, traumatología, imagenología, cirugía e identificación humana.

The meningo orbital foramen (MOF) is located in the major wing of the sphenoid and near the lateral end of the superior orbital fissure (SOF), communicating orbit with the middle cranial fossa and allowing the passage of an anastomosis between the ophthalmic and middle meningeal arteries. Its prevalence varies from 6 to 82.9 % and may occur unilaterally or bilaterally, single or multiple, and may have a circular, ovoid or groove form. The aim of this study is to evidence the existence of MOF, describing its morphological characteristics in dry skulls of Chilean adults of both sexes. The present study analyzed 54 skulls containing both orbits, considering the following criteria: Existence, unilaterality or bilaterality, number of foramens by orbit, shape, location in relation to the horizontalbaselinedetermined by the lateral end of the SOF, distance to the lateral end of the SOF and diameter and variations by sex. Measurements were made with nylonprobe,compass dry point and digital caliper. Of the sample, 46.29 % presented MOF with a greater prevalence in female samples. In 28 % of the cases it was unilateral and in the other 72 % bilateral. The circular shape was predominant in 79.07 %, followed by the ovoidal 18 % and thegrooveform 2.33 %. The MOF was observed in 90.69 % on the horizontalbaselinethat determines the lateral end of the SOF and in 9.31 % in the samebaseline. The average distance from the MOF to the lateral end of the SOF was 6.58 mm and the diameter of the MOF corresponded to 1.22 mm. Our results are consistentwith similar studies. There were some minor differences observed in Indian, Asian andPakistani skulls as well as some anatomical differences by sex. A better understanding of MOF plays an important role in anatomy, anthropology, ophthalmology, traumatology, medical imaging, surgery and human identification.

Refractory Spontaneous Chronic Subdural Hematoma: A Rare Presentation of an Intracranial Arteriovenous Fistula

The author has encountered a 67-year-old man with dural arteriovenous fistula (AVF) presenting as a non-traumatic chronic subdural hematoma (CSDH). This previously healthy patient was hospitalized due to progressive headache with subacute onset. He underwent burr-hole surgery twice for evacuating the left CSDH that was thickest at the posterior temporal area. The operative procedure and finding was not extraordinary, but subdural hematoma slowly progressed for days following the revision surgery. After investigation by super-selective external carotid angiography, a dural AVF found near the transverse-sigmoid sinus was diagnosed. Dural AVF was completely occluded with trans-arterial injecting polyvinyl alchol particles into the petrosquamosal branch of the middle meningeal artery. The patient showed a good neurological outcome with no additional intervention. Brain surgeons have to consider the possibility of dural AVF and perform cerebral angiogram if necessary when they manage the cases that have a spontaneously occurred and repeatedly recurring CSDH.

Transcranial Direct Middle Meningeal Artery Puncture for the Onyx Embolization of Dural Arteriovenous Fistula Involving the Superior Sagittal Sinus

A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.

An undocumented variation involving auriculotemporal nerve, inferior alveolar nerve and middle meningeal artery.

Auriculotemporal nerve typically has two roots, encircling the middle meningeal artery, one anterior to it and another posterior to it as well as maxillary artery. The middle meningeal artery is largest of the meningeal arteries, ascends between the sphenomandibular ligament and lateral pterygoid muscle and traverses between the roots of the auriculotemporal nerve before entering the cranial cavity through the foramen spinosum. The knowledge of the neurovascular relationships of the infratemporal region is significant in surgical practice. We present a case of unusual communication between the auriculotemporal nerve and inferior alveolar nerve together with an extraordinary change in relations with the middle meningeal artery. Some clinical implications that these relations may have on the development of the supplementary innervations and the surgical interventions in this region are discussed in this article.

Trifurcation of External Carotid Artery and Variant Branches of First Part of Maxillary Artery.

The external carotid artery normally divides into two terminal branches at the level of the neck of the mandible. The terminal branches are usually the superficial temporal and maxillary arteries. The maxillary artery is described to be in three parts in relation to the lateral pterygoid muscle as the mandibular (first), pterygoid (second) and the pterygopalatine (third) parts. The second part passes behind the muscle. The branches that arise from the first part of the maxillary artery are the deep auricular, anterior tympanic, the middle meningeal, accessory meningeal and inferior alveolar arteries. The middle meningeal artery normally arises at the lower border of lateral pterygoid muscle from the first part of maxillary artery. It then ascends upwards, passes between the two roots of the auriculotemporal nerve and enters the foramen spinosum in the base of skull. During routine dissection of a male cadaver in the department of anatomy while teaching medical students variations were observed in the termination of the external carotid artery on the right side. The artery gave three branches at the termination, superficial temporal, maxillary and between the two the middle meningeal artery was seen arising close to the end of the external carotid artery. The middle meningeal artery did not pass between the two roots of the auriculotemporal nerve. The branches of first part of maxillary artery were variable. The deep auricular branch was absent and its territory may have been supplied by the posterior auricular and anterior auricular arteries. The anterior tympanic and accessory meningeal arteries arose from the middle meningeal artery. There were two inferior alveolar arteries 1.5 cm apart arising from the first part of maxillary artery. The first artery went to the mandibular canal along with the inferior alveolar nerve. The second artery accompanied the lingual nerve to the last molar tooth. Probably this artery may have been an additional supply to the gingiva around the last molar tooth. The other variations that were noted were the absence of mylohyoid branch from the inferior alveolar artery. To the best of our knowledge these variations in the arteries have not been previously reported.

Angiographically Progressive Change of Traumatic Pseudoaneurysm Arising from the Middle Meningeal Artery

Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare phenomenon, which are usually associated with head trauma such as an underlying skull fracture. They were usually known to cause acute or delayed epidural hematomas but can be associated with subdural, subarachnoid, or even intracerebral hemorrhage. Sometimes, a high mortality rate was reported in these circumferences. But the natural course of these pseudoaneurysms is not well recognized. The indication and guideline of treatment for pseudoaneurysm are also unclear. This report describes a rare case of angiographically progressive change of traumatic pseudoaneurysm of the middle meningeal artery for one week, which was treated with endovascular embolization.

Middle Meningeal Artery Arising from the Basilar Artery

Various anomalies for the origin of the middle meningeal artery (MMA) have been described in the literature. However, origin of the MMA from the basilar trunk is an extremely rare variant. We report on a 54-year-old female who presented with frequent headaches; magnetic resonance imaging showed a right parietal meningioma. The abnormal origin of the middle meningeal artery from the basilar artery was diagnosed by angiography performed for preoperative embolization of the tumor. We report on the case with a review of the embryologic basis, possible explanations for this aberrant origin, and its clinical implications.

Origins of the middle meningeal artery and its probableembryological mechanism: a review

The middle meningeal artery is traditionally described by the human anatomy books as having its origin inthe first portion of the maxillary artery. However, more detailed studies have shown that there are numerousvariations on this arterial segment with considerable clinical importance. Therefore, the aim of this study wasto perform a wide review about this aspect analyzing scientific articles and textbooks. Thus, this review shallbe useful for clinicians, surgeons and academics that manipulate and keep interest for this particular anatomicalsite.

Clinical significance of maxillary artery and its branches: a cadaver study and review of the literature / Significado clínico de la arteria maxilar y sus ramas: un estudio en cadáver y la revisión de la literatura

The aim of this study was to investigate the anatomy of the maxillary artery (MA) and its branches. Fourteen sides of Turkish adult cadavers were dissected. The specimens were classified according to the relation between MA and the lateral pterygoid. After the removal of the lateral pterygoid, parts and branches of MA were exposed. We classified the branching patterns of MA in the pterygopalatine fossa. The calibers and lengths of the arteries, and the distance between the zygomatic arch and MA, and between the infratemporal crest and MA were measured. The MA was found superficial to the lateral pterygoid in 57.2 percent. The inferior alveolar artery (IA) was arisen from MA before the middle meningeal artery (MM) in 35.7 percent, after MM in 35.7 percent. The IA and MM were arisen from the same area of MA in 14.3 percent. In other two cases IA was arisen from the beginning of MA (14.3 percent). According to the contours of third portion of MA, we classified "Y" type (50 percent), "intermediate-T" type (14.3 percent), and "M" type (35.7 percent). This reinvestigation of the clinical anatomy of MA may provide useful information to the head and neck surgeons, dentists, neurosurgeons and radiologists related with this region.

El objetivo de este estudio fue investigar la anatomía de la arteria maxilar (AM) y sus ramas. Fueron disecados 14 hemicabezas de cadáveres turcos adultos. Las muestras fueron clasificadas de acuerdo a las relaciones entre AM y el músculo pterigoideo lateral. Después de la eliminación del músculo pterigoideo lateral, las partes y las ramas de AM fueron expuestas. Se clasificaron los patrones de ramificación de la AM en la fosa pterigopalatina. El calibre y la longitud de las arterias, la distancia entre el arco cigomático y la AM , y entre la cresta infratemporal y la AM fueron medidas. La AM se encuentra superficial al músculo pterigoideo lateral en el 57,2 por ciento. La arteria alveolar inferior (AI) se originó desde la AM antes que la arteria meníngea media (MM) en el 35,7 por ciento, y después de ésta en el 35,7 por ciento. La AI y MM se originaron en la misma zona de la AM en el 14,3 por ciento. En otros dos casos la AI se originó desde el inicio de AM (14,3 por ciento). De acuerdo con los contornos de la tercera porción de AM, se clasificaron como tipo "Y" (50 por ciento), tipo "intermedio-T" (14,3 por ciento), y de tipo "M" (35,7 por ciento). Esta investigación de la anatomía clínica de la AM puede proporcionar información útil a los cirujanos de cabeza y cuello, odontólogos, neurocirujanos y radiólogos relacionados con esta región.

Intracerebral Hematoma Caused by Ruptured Traumatic Pseudoaneurysm of the Middle Meningeal Artery: A Case Report

Hematomas caused by ruptured traumatic pseudoaneurysms of the middle meningeal artery (MMA) usually present with extradural hematomas, whereas intradural intraparenchymal hematomas are extremely rare. We report a case of traumatic pseudoaneurysm of the MMA giving rise to an intracerebral hematoma after head trauma. A 70-year-old man suffered a massive intracerebral temporoparietal hemorrhage after a head injury. CT angiogram of the brain revealed a large hematoma in the right middle cranial fossa extending to the right sylvian fissure. Cerebral angiogram also revealed a pseudoaneurysm of the MMA, which was successfully treated surgically. Although traumatic MMA pseudoaneurysm producing intracerebral hematoma (ICH) is rare, it should be considered as a possible cause of intracerebral hematoma.

Extradural Hematoma - An Experience of 300 Cases

Three hundred cases of extradural haematoma seen over a period of nine years from June 1995 to May 2004 in Neurosurgery unit of Postgraduate Department of Surgery, Government Medical College, Jammu were analysed retrospectively for their clinical profile and operative measures. Their clinical presentation varied from intense headache to deep coma and fixed pupil. Two hundred forty five of them were operated and rest managed conservatively. Overall mortality in operated cases was 14%. Cases managed conservatively were monitored closely and serial CT Scans were done to assess progress. In two cases we had to operate as haematoma increased in size.