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The Accessory Meningeal Artery of Man* by Julian J

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The Accessory Meningeal Artery of Man* by Julian J [ 386] THE ACCESSORY MENINGEAL ARTERY OF MAN* BY JULIAN J. BAUMEL AND DONALD Y. BEARD Department of Anatomy, School of Medicine, Creighton University Omaha, Nebraska, U.S.A. INTRODUCTION The accessory meningeal artery usually receives only perfunctory mention in most textbooks of anatomy. In the average textbook account the artery at times is described as a branch of the middle meningeal artery; at other times as a branch of the maxillary artery. The account is continued by stating that the accessory menin- geal enters the foramen ovale and supplies the semilunar ganglion and adjacent dura mater. Throughout the paper this version will be referred to as the' stereotyped' or 'abbreviated' account. During routine laboratory dissections, our attention was initially called to two cadavera in which the accessory meningeal arteries failed to conform to the stereo- typed description in that much of their distribution went to extracranial structures. Perusal of accounts of the artery in texts and atlases revealed a diversity of descrip- tions, which, coupled with additional observations in the laboratory, led to the conclusion that the accessory meningeal artery should be re-investigated. HISTORY Numerous anatomical works have been consulted in tracing the record of the acces- sory meningeal artery. These range chronologically from mid-eighteenth century to contemporary, and include as many as could be obtained of the widely used and acknowledged classical texts and references. In the historical synopsis set down below an attempt has been made to include representative works of each generation. It has become evident to us that the treatment accorded the acc. mening. a. has, in general, degenerated or devolved with the passage of time rather than evolved into more perfect form. That is, some of the earlier anatomists have described the acc. mening. a. much more adequately than have their successors. (Michels (1960) has commented on an analogous situation with regard to the middle hepatic artery.) In the historical survey we noted: (1) that the acc. mening. a. is often described as an inconstant vessel; (2) that many authors have failed to call attention to the variable origin of the artery; (3) that many authors have overlooked the rather extensive extracranial distribution of the artery or have shifted inordinate emphasis over to the intra- cranial distribution. The acc. mening. a. has been called by a multiplicity of terms; according to the Paris Revision of the Nomina Anatomica (1955) it is designated as the Ramus meningeus accessorius of the Arteria meningea media. In light of the findings of * This investigation was supported in part by funds from the Nebraska Heart Association. The accessory meningeal artery of man 387 the present study, it seems that A. meningea accessoria is a less inappropriate name, the anglicized form ofwhich will be followed throughout this paper. Further remarks on this topic are made in the discussion. Other synonyms by which the acc. mening. a. has been known are set down below: A. meningea parva, R. meningeus parvus, small meningeal artery; A petite meningee, arteria parvae, lesser meningeal artery; A. meningea media parva. Parvidural branch of middle meningeal artery. A. meningea media accessoria, accessory middle meningeal artery. A. pterygoidea externa. A. pterygo-meninge, R. meningeae pterygoideus. A. meningica accessoria. The earliest account of the acc. mening. a. available to us is from the Icones of Haller (1745). According to Barclay (1812) Haller was the first anatomist to describe minutely the int. max. a. Haller says that the acc. mening. springs from the max. a. anterior to the mid. mening., but most often from the mid. mening. itself. He cites the earlier works of Winslow and Gunz who also noted the origin from max. a., and observes that the main stem of the acc. mening. enters the cranium via foramen ovale. A more comprehensive description is that of S6mmering (1792) who indicates that the acc. mening. stems from the int. max. a. and distributes to both pterygoid mm., to mm. of the auditory tube, to the third branch of the fifth nerve, and to dura mater. He did not treat the course and relationships as thoroughly as Haller. Barclay in his description of the arteries of the human body briefly alludes to the acc. mening. a. thus: '. a Ramulus is observed running along the third branch of the fifth pair of nerves to the Dura Mater.' He refers to it as a branch of the int. max. a. According to Meckel (1832) the acc. mening, is an inconstant branch of the int. max., which often arises from mid. mening. or a pterygoid artery, that sends branches to pterygoid mm., mm. of soft palate, and sometimes into skull to dura mater near the sella turcica. Meckel observes that the small mening. a. sometimes replaces deficient extracranial collaterals of the mid. mening. a. Bell's Anatomy (1834), referring to the int. max. a., states only, 'a branch of it sometimes goes into the skull by that hole named foramen ovale... and goes to that part of the dura mater which covers the sides of the sella turcica.' The most comprehensive and accurate of the earlier presentations appears to be that of Bourgery (1835). This author says the acc. mening., frequently lacking, springs from either mid. mening. or int. max. trunk distal to the origin of the inf. dental a. He describes its ascent between the pterygoid mm., providing variable arterioles to both of these muscles and at the base of the skull the artery's division into two rami: the decending rams which winds about the superior attachment of the med. pt. m. and is lost in the wall of the nasal fossa and the soft palate; the ascending rams which penetrates into the cranium, distributes to the dura and trigeminal nerve, and there anastomoses with rami of the internal carotid and mid. mening. aa. Tiedemann's plates (Knox, 1835) of the arteries of the human body fail to illustrate the acc. mening. a. Wistar's text (1843) indicates only that the acc. mening. arises from int. max., ascends to foramen ovale, and passes to dura after having supplied branches to external pterygoid and mm. of the palate. Quain's monograph (1844) on the arteries 388 Julian J. Baumel and Donald Y. Beard discusses the acc. mening. only in a legend to a plate. He states the artery originates from mid. mening., giving off a small branch which ramifies 'over the large plexus of veins in this situation after having furnished a meningeal branch through the foramen ovale of the sphenoid bone...'. Quain's and Wilson's Atlas (1845) calls attention to a feature unmentioned in earlier works. This is the course of the ace. mening. in relation to the 'pterygoid plate and circumflexus palati'. The only distribution indicated is to dura. Cruveilhier's (1851) description of the ace. mening. does little more than paraphrase the excellent one of Bourgery; however, the name, A. pterygo-meninge, applied by Cruveilhier to the artery is significant and will be mentioned later. Power's (1860) account of the artery adds nothing despite his extensive section on variation. Barkow's plates (1866) offer no references to the ace. mening. a. The works of both Luschka (1867) and Henle (1876) provide satisfactory descrip- tions; both mention origin of the ace. mening. from mid. mening. or int. max. aa. and distribution to pterygoid mm. Luschka includes rami to the soft palate and mandi- bular nerve. Henle adds the auditory tube and descending palatine mm. Both authors indicate that the ace. mening. terminates within the cranium. The eighth edition of Quain's Elements (Sharpey, Thomson &Schafer, 1876) merely presents an abbreviated version. Gegenbaur (1896) mentions the variable origin of the artery as well as rami to pterygoidei and palate. He furthermore correctly notes the relatively small size of the intracranial ramus. Spalteholz, in the first edition (1898) of his Handatlas, as well as later ones, departs from the usual accounts of the artery by describing only an extracranial distribution of the ace. mening. a. Testut (1900), Poirier & Charpy (1901), Gray's Anatomy (1901), Cunningham (1906), Sobotta & McMurrich (1911), Testut & Jacob (1914), and Corning (1914) write only abbreviated versions of the ace. mening. a. Only a few of these signify any distribution other than the familiar 'semilunar ganglion and adjacent dura'. The variable origin of the artery is referred to only rarely. Chiarugi (1924), Gerard (1921), Toldt (1928), and Piersol (1930) likewise provide only stereotyped accounts of the artery. Adachi's (1928) monograph on the arterial system of the Japanese has no textual description of the ace. mening. and only a single unlabelled figure to show its existence. Tandler's (1926) account of the artery is similar to those of Luschka and Henle. Later editions of some of the long-in-print, standard texts and atlases already cited, as well as many of the newer works on gross anatomy, have been reviewed. Most show no noteworthy improvements in the treatment of the ace. mening. a. However, from this assemblage, attention should be directed to the texts of Benninghoff (1952) and Rauber-Kopsch (Kopsch 1955) who properly indicate the supply of the pterygoid mm., mm. of the palate, as well as the auditory tube, semilunar ganglion and dura. Pernkopf's textual description of the artery (1957) is the stereotyped one. Several of his plates (1952, 1957) accurately illustrate (but do not designate) some of the principal and consistent extracranial rami we have observed. Paturet (1958) neglects to mention many of the extracranial structures supplied by the ace. mening. but does give the most comprehensive.description of supply to intracranial structures we have encountered. Our review of the literature failed to reveal works dealing specifically with the ace.
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