Anatomy of the Middle Meningeal Artery

Introduction The middle meningeal artery (MMA) is an important artery in neurosurgery. As the largest branch of the maxillary artery, it provides nutrition to the meninges and to the frontal and parietal regions. Diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (TAVF), Moya-Moya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine, and meningioma,may be related to the MMA. The aim of the present study is to describe the anatomy of the MMA and to correlate it with brain diseases. Methods A literature review was performed using the PubMed, Scielo, Scientific Direct, Ebsco, LILACS, TripDataBase and Cochrane databases, with the following descriptors: neurosurgery, neuroanatomy, meninges and blood supply. Discussion The MMA is embedded in a cranial groove, and traumatic or iatrogenic factors can result in MMA-associated pseudoaneurysms or arteriovenous fistulas (AVFs). In hemodynamic stress, true aneurysms can develop. Arteriovenous fistulas, pseudoaneurysms, and true aneurysms can be effectively treated by endovascular or surgical removal. In MMD, the MMA plays a role in the development and in the improvement of collateral circulation. Finally, in cases of CSDH, when standard surgery and drainage fail, MMA embolization can constitute a great alternative. Conclusion The MMA is a relevant structure for the understanding of neurosurgical diseases. In conclusion, every neurosurgeon must know the anatomy of the MMA sufficiently to correlate it with the diagnosed pathology, thus obtaining treatment effectiveness and preventing brain lesion.

Angina cervical: relato de caso / Cervical angina: report of case

A angina cervical (AC) é uma síndrome clínica que apresenta diagnóstico diferencial com a angina pectoris, comumente subdiagnosticada. Sua prevalência necessita de dados pela dificuldade diagnóstica como também pela realização de exames e procedimentos desnecessários. A causa mais comum da AC é a compressão das raízes nervosas cervicais. A discectomia cervical tem sido realizada no seu tratamento. Os autores apresentam um caso de angina cervical e discutem seu diagnóstico e conduta.

Cervical angina (AC) is a clinical syndrome that presents differential diagnosis of angina pectoris, commonly misdiagnosed. Its prevalence requires data by diagnostic difficulty and the performance of unnecessary tests. The most common cause of the compression of the cervical nerve roots. The cervical discectomy has been performed in its treatment. The authors present a case of cervical angina and discuss their diagnosis and therapy.

Hemorragia intracraniana por malformação arteriovenosa na Gravidez: relato de caso e revisão de literatura(AU) / Intracranial hemorrhage in arteriovenous malformation in pregnancy: a case report and literature review

A hemorragia intracraniana espontânea (HIE) que ocorre durante a gravidez ou puerpério é rara. A malformação arteriovenosa(MAV) intracraniana é responsável por cerca de 20% a 48% das HIE durante a gestação e puerpério. Convulsão, cefaleia,déficits neurológicos e alterações do nível de consciência podem ser as manifestações inicias em gestantes com HIE devido àMAV. Os autores relatam um caso de MAV em uma paciente de 21 anos de idade, no 4º mês de gravidez e discutem conduta eprognóstico.