Middle meningeal artery !

The middle meningeal artery runs on the inside of the skull at the temple; a skull fracture there can tear it and cause an epidural haematoma.

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What it is

An artery under the pterion, inside the skull; a fracture there can tear it and cause an epidural haematoma.

What it does

Feeds the dura and skull; a skull fracture can tear it, causing an epidural haematoma.

Key facts

Origin: Maxillary artery; enters through the foramen spinosum
Branches: Frontal and parietal branches
Supplies: Dura and skull; frontal branch under the pterion (epidural haematoma)

Relations

Course: From the first part of the maxillary artery in the infratemporal fossa it rises deep to the lateral pterygoid, through the loop of the auriculotemporal nerve, enters the middle cranial fossa through the foramen spinosum and runs out across its floor; the frontal branch climbs to the pterion and the parietal branch runs backward
Superficial: Inner table of the skull, which it grooves; at the pterion, where the frontal, parietal, temporal and sphenoid bones meet, the bone is thin
Deep: Dura mater, in whose outer layer it runs, and beneath it the temporal and frontal lobes

How to find it

The pterion, over the frontal branch, lies about two finger-breadths above the zygomatic arch and a thumb's breadth behind the frontal process of the zygomatic bone.

On imaging

Non-contrast CT: a bright biconvex collection under the temple, often with a fracture crossing the vessel groove on bone windows; darker swirls inside it suggest active bleeding. On plain skull films the vascular grooves can look like a fracture.

Common problems

Epidural haematoma: bleeding between skull and dura, usually from the middle meningeal artery after a blow; the person may seem fine at first, then worsens.
Subdural haematoma: bleeding under the dura from torn veins, common in older adults and people on blood thinners.

How it is diagnosed

Emergency CT of the head.

Treatment

Observation for small bleeds.
Urgent craniotomy or burr holes to remove the blood.

Clinical notes

Arterial bleeding grows fast: the clot can push the medial temporal lobe through the tentorial notch (uncal herniation), compressing the oculomotor nerve and the brainstem
A large epidural haematoma is an emergency treated by surgical evacuation through a craniotomy
Embolisation of the middle meningeal artery is used to lower the recurrence of chronic subdural haematoma, whose membranes it supplies
When cut it bleeds from both ends, because its branches anastomose with the other meningeal arteries and with the opposite side; at the pterion its frontal branch may run in a bony tunnel, so a fracture there tears it easily

Anatomical variants

Rarely the ophthalmic artery arises from it, or the two share a large orbital link; this matters before embolisation
An accessory meningeal artery may arise from it or from the maxillary artery

Development

It is a remnant of the embryonic stapedial artery, whose trunk passes between the two roots of the auriculotemporal nerve; its small orbital twigs are what is left of the stapedial branch to the orbit, explaining links with the ophthalmic artery.

Memory aid

Epidural = lens, stopped by the sutures; subdural = crescent, crossing the sutures.

Test yourself

Think of the answer, then tap the question to see it.

From which artery does the middle meningeal artery arise, and through which foramen does it enter the skull?

The first part of the maxillary artery; it enters the middle cranial fossa through the foramen spinosum.

What is the classic course of an epidural haematoma from a torn middle meningeal artery?

A blow to the temple tears the frontal branch under the pterion; a lucid interval, then drowsiness, a dilated pupil on that side and weakness of the other side.

What does an epidural haematoma look like on CT, and why?

Lens-shaped (biconvex) and stopped by the sutures, where the dura is firmly attached to the bone.

Why is the middle meningeal artery embolised in chronic subdural haematoma?

It supplies the haematoma's membranes; embolisation lowers the recurrence.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): arteria meningea media TA2 4431
Official Spanish (DeCS): Arteria meníngea media DeCS D008576
English (TA2): Middle meningeal artery
Also called: arteria meningica media

Sources: Terminologia Anatomica (TA2); DeCS; Neuroanatomy, Middle Meningeal Arteries; Anatomy of the Human Body (20th ed.): Development of the Vascular System (Lea & Febiger (Gray's Anatomy, 1918), 1918) · adapted, Public domain; Tratado de anatomía humana (9.ª ed.), tomo II, Libro IV, sección 2 Arterias, caps. I-III (sistema de la arteria pulmonar; aorta y ramas del cayado hasta la carótida interna).

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Representative model, for educational purposes only.

Middle meningeal artery highlighted on the Durgical 3D model