Bilateral pterygomeningeal arteries penetrating the skull anterior to the foramen ovale.

PURPOSE: The pterygomeningeal (accessory meningeal) artery is an inconstant branch of the middle meningeal or maxillary artery. A variant that penetrates the skull anterior to the foramen ovale is rare, and bilateral coexistence has not been reported. A cadaver with bilateral variants of this type is described.

METHODS

The head of a 79-year-old man was examined during a gross anatomy course. Origin, course, and relations of the variant vessels were recorded on both sides.

RESULTS

On the left, an accessory middle meningeal branch of the middle meningeal artery penetrated the greater wing approximately 4 mm anterior to the foramen ovale, became enclosed within the maxillary nerve, passed together through the foramen rotundum, and descended anteroinferiorly in a narrow interlaminar space between two firm laminae along the posterior maxilla. No alveolar foramina were present in the maxillary tuberosity. On the right, an accessory middle meningeal artery arose from the maxillary artery, penetrated the skull anterior to the foramen ovale, and gave branches on the inferior surface of the trigeminal ganglion.

CONCLUSION

In the present case, bilateral pterygomeningeal variants penetrated the skull anterior to the foramen ovale. The left-sided continuation through the foramen rotundum with the maxillary nerve has not been described in detail. The bony openings may be related to the foramen of Vesalius, but this could not be confirmed. These findings are of anatomical and potential clinical relevance for interpreting unusual skull-base vascular pathways and for procedures involving the posterior maxillary region, although their clinical significance requires further investigation.