Distribution of the Middle Meningeal Artery Variants in Patients Undergoing Embolization for Chronic Subdural Hematoma

BACKGROUND: The middle meningeal artery (MMA) is a major dural vessel that plays a significant role in developing chronic subdural hematomas (cSDHs). Understanding its variable anatomy is essential for the effective management of cSDH and the prevention of complications. METHODS: MMA anatomy was retrospectively assessed in a population of 92 patients who underwent digital subtraction angiography of cerebral vessels before MMA embolization for cSDH. RESULTS: We assessed 121 MMAs in 92 patients who underwent digital subtraction angiography for cSDH treatment from October 2020 to July 2023. The most common type in the extended Adachi classification was IC (19.82%) and the rarest was IB (6.31%). The anterior branch of the MMA was the most frequently dominant, while the most common origin of the posterior branch was observed in the distal segment. We reported 4 cases (3.31%) of the MMA arising from the ophthalmic artery. CONCLUSIONS: The most common configuration of MMA was Adachi-type IC. The MMA most often originated from the maxillary artery. The posterior branch of the MMA was typically dominant and most frequently originated from the distal segment. There was no significant impact of Adachi type on treatment results or fluoroscopy time.