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Middle meningeal artery

The middle meningeal artery (MMA) is the largest branch of the maxillary artery, itself a terminal branch of the external carotid artery. It enters the cranial cavity through the foramen spinosum and runs between the dura mater and the inner table of the skull. The artery divides into frontal (anterior) and parietal (posterior) branches, which course beneath the skull bones, supplying the dura mater, calvarial bone, and cranial periosteum.

The MMA is clinically significant because it is the most common source of traumatic epidural hematomas when lacerated, particularly along the pterion, where the artery runs close to the thin temporal bone.

Synonyms

  • MMA

  • Dural branch of maxillary artery

  • Arteria meningea media

Function

  • Provides arterial supply to the dura mater of the anterior and middle cranial fossae

  • Supplies the inner table of cranial bones and periosteum

  • Contributes to the vascularization of cranial nerves and meninges

  • Clinical importance: rupture leads to epidural hematoma

MRI Appearance

T1-weighted images (non-contrast):

  • MMA appears as a linear flow void (black signal) along the dura

  • Difficult to follow without angiographic techniques

T2-weighted images:

  • Also seen as flow voids within the dura, with adjacent dura sometimes visible

  • Adjacent hyperintensity may be seen with hematoma, dural thickening, or inflammatory changes

MRA (Magnetic Resonance Angiography):

  • TOF and contrast-enhanced MRA clearly depict the origin from the maxillary artery, entry via foramen spinosum, and bifurcation into anterior and posterior branches

  • Useful for evaluating stenosis, aneurysms, arteriovenous fistulas, or vascular malformations

T1 Post-Contrast (Gadolinium-enhanced MRI):

  • Shows avid enhancement of the MMA and its branches

  • Enhancing linear dural vessels are identifiable against non-enhancing adjacent bone

  • Particularly useful for dural arteriovenous fistulas or hypertrophied MMA branches

CT Appearance

Non-contrast CT:

  • The MMA is not directly visualized

  • Its course can be inferred from grooves on the inner table of the skull, especially in the temporal and parietal bones

  • Acute rupture leads to biconvex (lentiform) epidural hematoma adjacent to its course

CT Angiography (CTA):

  • Demonstrates the MMA origin, intracranial course, and bifurcations

  • Shows contrast-filled lumen with excellent resolution of dural branches

  • Crucial for planning embolization of MMA in chronic subdural hematoma or AVM management

MRI images

Middle meningeal artery