title: Can blockage or sacrifice of the middle meningeal artery lead to hydrocephalus?
abstract: BACKGROUND
  The middle meningeal artery (MMA) is often sacrificed during neurosurgical procedures in the region of the pterion. This maneuver, herein, is hypothesized to be a potential reason for the development of postoperative hydrocephalus by injuring the vascular supply to the arachnoid granulations near the vertex of the skull, and thus disrupting their ability to allow for transfer of CSF from the subarachnoid space to the venous system.
  
  
  METHODS
  To test this theory, the middle meningeal artery was isolated at the skull base and injected with India ink. Next, the superior sagittal sinus was opened and the arachnoid granulations inspected.
  
  
  RESULTS
  All specimens demonstrated ink within the arachnoid granulations indicating that their blood supply is completely or at least partially via the middle meningeal artery. This finding with an illustrative case of surgical cautery of the middle meningeal artery at the skull base with subsequent development of hydrocephalus supports our hypothesis of potential role of iatrogenic MMA injury causing hydrocephalus.
  
  
  CONCLUSIONS
  Our cadaveric study shows that the blood supply of the arachnoid granulations of the superior sagittal sinus is via the middle meningeal artery. Additional cases of postoperative hydrocephalus following middle meningeal artery sacrifice are needed to support our hypothesis.
authors.affiliation: Seattle Science Foundation, Seattle, WA, USA. shane.tubbs@childrensal.org.|Department of Anatomical Sciences, St. George's University, True Blue, Grenada. shane.tubbs@childrensal.org.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: Seattle Science Foundation, Seattle, WA, USA.
authors.forename: Amin
authors.initials: A
authors.lastname: Demerdash
authors.affiliation: Department of Pathobiology, The Sophie Davis School of Biomedical Education, City College of New York, City University of New York, New York, NY, USA.
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Antoni
authors.affiliation: Department of Anatomical Sciences, St. George's University, True Blue, Grenada.
authors.forename: Marios
authors.initials: M
authors.lastname: Loukas
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, IN, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Kulwin
authors.affiliation: Swedish Neuroscience Institute, Seattle, WA, USA.
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Oskouian
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, IN, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Cohen-Gadol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001099:Arachnoid / Q000098:blood supply*; D002102:Cadaver; D002648:Child; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology*; D008297:Male; D008576:Meningeal Arteries / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*
keywords: Arachnoid granulations; Blood supply; Complications; Hydrocephalus; Neurosurgery; Skull base; Superior sagittal sinus; Treatment