E-053 Anomalous origin of the middle meningeal artery from mid-basilar artery

IntroductionThe middle meningeal artery (MMA) most commonly originates from the maxillary artery and travels through the foramen spinosum. Most variants have been noted to originate from the ophthalmic artery or the internal carotid artery. Rarely, an origin from the basilar artery has been observed. Here we present the case of anomalous origin of the MMA from the basilar artery in a pediatric patient with left facial hemangioma also supplied by the aberrant basilar branch in the setting of PHACES syndrome.Case historyA 2-year-old female toddler with a left facial hemangioma and left lid lag presented for diagnostic cerebral angiogram to further characterize a large fusiform left posterior communicating artery aneurysm with involvement of the left internal carotid artery, anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA).We here report a case of anomalous origin of the MMA from the basilar artery with literature review.Methods and resultsIntracranial MR angiography, digitally subtracted cerebral angiography, including rotational three-dimensional angiography, with a left internal carotid artery injection and left vertebral artery injection was performed. A large fusiform left posterior communicating artery aneurysm was noted with involvement of the carotid terminus, as well as proximal aspects of the left ACA, MCA and PCA. Additionally, a large branch off the basilar artery at the level of the pons was noted originating between the left superior cerebellar artery and the left anterior inferior cerebellar artery, both of which were relatively diminutive. The vessel traveled anteriorly through the cavernous sinus and into the middle cranial fossa where it branched into the MMA and a vessel that traveled through the optic canal and exited beneath the superior orbital rim to supply the large left facial hemangioma. No associated intracranial vascular malformation was noted.ConclusionWe describe a rare case of anomalous origin of the MMA from the basilar artery in a pediatric patient, in the setting of PHACES syndrome. Only seven cases of the MMA originating from the basilar artery have been reported previously, including one case of bilateral anomalous origin. In each of these cases, the MMA originated from an enlarged basilar branch between ipsilateral the superior cerebellar artery and anterior inferior cerebellar artery, as was noted in our case. This anomaly has been proposed to be the result of an anastamosis