It aims to highlight the importance of anatomical variations of the (MMA) middle meningeal artery's origin in practice for neurointerventionalist. Before proceeding with embolization of the MMA in some pathologies, a critical analysis of the anatomy of these vessels should be done. When MMA originates from the ophthalmic artery, it is a formal contraindication to proceed with the embolization.¹1 Bonasia S, Smajda S, Ciccio G, Robert T. Middle Meningeal Artery: Anatomy and Variations. AJNR Am J Neuroradiol 2020;41(10):1777–1785. Doi: 10.3174/ajnr.A6739
https://doi.org/10.3174/ajnr.A6739... ,²2 Liu Q, Rhoton AL Jr. Middle meningeal origin of the ophthalmic artery. Neurosurgery 2001;49(02):401–406, discussion 406–407. Doi: 10.1097/00006123-200108000-00025
https://doi.org/10.1097/00006123-2001080... Otherwise, major complications is embolization of the central retinal artery results in blindness.³3 Fantoni M, Eliezer M, Serrano F, et al. High frequency of ophthalmic origin of the middle meningeal artery in chronic subdural hematoma. Neuroradiology 2020;62(05):639–644. Doi: 10.1007/s00234-020-02363-6
https://doi.org/10.1007/s00234-020-02363...

A patient with recurrent chronic subdural hematoma and thrombocytopenia was referred to embolization of the MMA. Angiogram shows MMA originates in the OA, and the procedure was inadvisable (Figures 1 and 2).

Figure 1
Lateral view of a cerebral angiogram showing a right subdural hematoma and the right middle meningeal artery originates from the ophthalmic artery.

Figure 2
Anteroposterior view of a cerebral angiogram showing a right subdural hematoma and the right middle meningeal artery originates from the ophthalmic artery.

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