R Shane Tubbs1,2, Amin Demerdash3, Anthony V D'Antoni4, Marios Loukas5, Charles Kulwin6, Rod J Oskouian7, Aaron Cohen-Gadol6. 1. Seattle Science Foundation, Seattle, WA, USA. shane.tubbs@childrensal.org. 2. Department of Anatomical Sciences, St. George's University, True Blue, Grenada. shane.tubbs@childrensal.org. 3. Seattle Science Foundation, Seattle, WA, USA. 4. Department of Pathobiology, The Sophie Davis School of Biomedical Education, City College of New York, City University of New York, New York, NY, USA. 5. Department of Anatomical Sciences, St. George's University, True Blue, Grenada. 6. Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, IN, USA. 7. Swedish Neuroscience Institute, Seattle, WA, USA.
Abstract
BACKGROUND: The middle meningeal artery (MMA) is often sacrificed during neurosurgical procedures in the region of the pterion. This maneuver, herein, is hypothesized to be a potential reason for the development of postoperative hydrocephalus by injuring the vascular supply to the arachnoid granulations near the vertex of the skull, and thus disrupting their ability to allow for transfer of CSF from the subarachnoid space to the venous system. MATERIALS AND METHODS: To test this theory, the middle meningeal artery was isolated at the skull base and injected with India ink. Next, the superior sagittal sinus was opened and the arachnoid granulations inspected. RESULTS: All specimens demonstrated ink within the arachnoid granulations indicating that their blood supply is completely or at least partially via the middle meningeal artery. This finding with an illustrative case of surgical cautery of the middle meningeal artery at the skull base with subsequent development of hydrocephalus supports our hypothesis of potential role of iatrogenic MMA injury causing hydrocephalus. CONCLUSIONS: Our cadaveric study shows that the blood supply of the arachnoid granulations of the superior sagittal sinus is via the middle meningeal artery. Additional cases of postoperative hydrocephalus following middle meningeal artery sacrifice are needed to support our hypothesis.
BACKGROUND: The middle meningeal artery (MMA) is often sacrificed during neurosurgical procedures in the region of the pterion. This maneuver, herein, is hypothesized to be a potential reason for the development of postoperative hydrocephalus by injuring the vascular supply to the arachnoid granulations near the vertex of the skull, and thus disrupting their ability to allow for transfer of CSF from the subarachnoid space to the venous system. MATERIALS AND METHODS: To test this theory, the middle meningeal artery was isolated at the skull base and injected with India ink. Next, the superior sagittal sinus was opened and the arachnoid granulations inspected. RESULTS: All specimens demonstrated ink within the arachnoid granulations indicating that their blood supply is completely or at least partially via the middle meningeal artery. This finding with an illustrative case of surgical cautery of the middle meningeal artery at the skull base with subsequent development of hydrocephalus supports our hypothesis of potential role of iatrogenic MMA injury causing hydrocephalus. CONCLUSIONS: Our cadaveric study shows that the blood supply of the arachnoid granulations of the superior sagittal sinus is via the middle meningeal artery. Additional cases of postoperative hydrocephalus following middle meningeal artery sacrifice are needed to support our hypothesis.
Authors: R Shane Tubbs; Marios Loukas; Mohammadali M Shoja; Nihal Apaydin; Mohammad R Ardalan; W Jerry Oakes Journal: J Neurosurg Date: 2008-05 Impact factor: 5.115
Authors: Philipp Hendrix; Christoph J Griessenauer; Paul Foreman; Mohammadali M Shoja; Marios Loukas; R Shane Tubbs Journal: Clin Anat Date: 2014-05-26 Impact factor: 2.414