Transarterial embolization of convexity meningioma via the meningolacrimal artery through the ophthalmic artery: A case report with embryological insights.

The presence of dangerous anastomoses between the ophthalmic artery (OphA) and the middle meningeal artery has the potential risk of causing visual function complications during transarterial embolization. The present case was a 69-year-old male with convexity meningioma. The main trunk of the middle meningeal artery was coagulation-cut at the level of the foramen spinosum because a combined petrosal approach was applied 22 years earlier at the time of craniotomy. Preoperative digital subtraction angiography showed the characteristic dual feeding pattern. The tumor was supplied with blood flow from the meningolacrimal artery, which is a branch of the OphA, and the anteromedial branch of the inferolateral trunk, which is a branch of the internal carotid artery (ICA), through the middle meningeal artery anastomoses on the dura mater. We successfully embolized the feeder transarterially through the meningolacrimal artery through the OphA. The presence of the dual feeding pattern from both the OphA and the inferolateral trunk of the ICA is rare, but embryological considerations gave us an important clue to understand the development of the angioarchitecture and evaluate treatment risks.