Microsurgical Anatomy of the Dural Arteries

Abstract

The carotid and vertebrobasilar arterial systems give rise to multiple branches that supply the dura in a complex and overlapping pattern. A knowledge of the microsurgical anatomy of these dural arteries and their assessment on pretreatment evaluations plays a major role in safe and accurate treatment of multiple lesions.

A Case of Lateral Medullary Artery Arisen from the Posterior Meningeal Artery

“…Furthermore, the PMA branching from the VA originates from the epidural area, showing a course into the cranium through the foramen magnum and reaching the dura mater of the posterior cranial fossa. 10,11) However, the PMA branching from the intradural VA, as demonstrated in the present case, shows a course involving the subdural cavity before reaching the site of dural distribution. At this site, a lateral medullapenetrating vessel may be present, as reported for the lateral medullary segment of the PICA.…”

“…Several studies reported anomalies, such as the PICA branching from the PMA 7) and PMA branching from the PICA. 8) In the embryonic phase, PICA-PMA anastomotic vessels are present, 9,10) as indicated between embryonicphase blood vessels; embryologically, a PICA-perfused area may be perfused from the PMA. Furthermore, the PMA branching from the VA originates from the epidural area, showing a course into the cranium through the foramen magnum and reaching the dura mater of the posterior cranial fossa.…”

Extracranial ligation of ethmoidal arteries before resection of giant olfactory groove or planum sphenoidale meningiomas: 3 illustrative cases with a review of the literature on surgical techniques

“…The location at the anterior skull base makes them amenable to a bicoronal subfrontal, oblique subfrontal, interhemispheric, or classic pterional transsylvian approach. 6,8,25,26 The subfrontal approach is popular due to easier access to the basal dural blood supply from the ethmoidal arteries, permitting earlier devascularization while providing the best view for cranial base repair with a pericranial flap. Apart from gaining control of the ethmoidal blood supply early during the surgery, endoscopic options for resection of these lesions are gathering momentum because of their minimally invasive nature and the decreased morbidity from reduced brain retraction.…”

“…6,8,25 These lesions are differentiated from posteriorly placed tuberculum sellae meningiomas in that the latter do not have a significant AEA supply and the olfactory nerves are superolateral, chiasm is inferolateral, and the ACA lies posterior or posterosuperior relative to the tumor. 7 When the olfactory groove meningiomas reach a giant size, there are occasionally branches from the ACAs and anterior communicating arteries that are also supplying them.…”

“…7 When the olfactory groove meningiomas reach a giant size, there are occasionally branches from the ACAs and anterior communicating arteries that are also supplying them. 7,25,32 The AEA is an orbital branch of the third segment of the ophthalmic artery and runs between the superior oblique and medial rectus muscles before leaving the orbit at the anterior ethmoidal foramen, together with the anterior ethmoidal nerve, to enter the roof of the ethmoidal sinus. It crosses the cribriform plate and enters the nose through a tiny slit adjacent to the crista galli to become the dorsal nasal artery, and also enters the cranial cavity near the cribriform plate to supply the dura mater of the anterior cranial fossa and the anterior part of the falx cerebri.…”