• Mithun G Sattur and Alejandro M Spiotta.
• Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA. Electronic address: sattur@musc.edu.
• World Neurosurg. 2020 Jan 1; 133: 84-89.

BackgroundThe middle meningeal artery (MMA) is an important conduit for the endovascular treatment of skull base and intracranial pathologies including, recently, subdural hematomas. A key aspect of such procedures is to perform a thorough diagnostic angiogram to detect anomalous arterial origins and "dangerous" anastomoses with branches of the internal carotid arteries. Although the most common anomaly related to the MMA is an abnormal origin from the ophthalmic artery, anomalous origin from the posterior circulation is rare. Moreover, its recognition requires a concerted effort at performing a vertebral artery angiogram irrespective of the location of the pathology (e.g., in subdural hematoma).Case DescriptionWe describe a case of anomalous origin of MMA from the basilar artery as a lateral pontine artery branch that was detected in a patient with recurrent subdural hematoma who presented for endovascular MMA embolization.ConclusionsThe embryologic origin of the entity is briefly discussed, along with suggestions for managing such an anomaly during endovascular embolization.Copyright © 2019 Elsevier Inc. All rights reserved.

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