Skip to main content
SpringerLink
Log in

Ophthalmic artery originating from the anterior cerebral artery: anatomo-radiological study, histological analysis, and literature review

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

The ophthalmic artery has an anomalous origin in 2–3 % of cases and rarely arises from the anterior cerebral artery. Herein, we provide the first anatomical, radiological, and histological description of such an anomalous origin, together with a literature review. During the anatomical dissection of an 81-year-old Caucasian male, the absence of the right ophthalmic artery in its usual location was evident from an endonasal transsphenoidal perspective. The specimen was then studied in detail, through multiple dissections, corrosion casting, high-resolution CT, and histological analysis. The English literature on anomalous origins of the ophthalmic artery was reviewed, together with reported associated pathologies. Anatomo-radiological analysis documented that the right ophthalmic artery arose from the inferior surface of A1 tract of the anterior cerebral artery (A1) and passed over the optic nerve in its subarachnoid tract. A meningo-ophthalmic artery was evident on the same side and reached the orbit through the superior orbital fissure. Histological examination of both internal carotid artery (ICA) walls documented a significantly decreased thickness of the tunica media and adventitia on the side of the anomalous ophthalmic artery, with a significantly different content of collagen types I and III. The literature review documented an association of aneurysms and anomalous ophthalmic arteries. To the best of our knowledge, this is the first anatomical report that includes a radiological and arterial wall analysis of a persistent ventral ophthalmic artery. The latter provides histological data that support the clinical evidence of a higher association of aneurysms with anomalous origins of the ophthalmic artery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

ICA:

Internal carotid artery

C3:

C3 tract of the internal carotid artery

C4:

C4 tract of the internal carotid artery

ECA:

External carotid artery

MDCT:

Multidetector computed tomography

CBCT:

Cone beam computed tomography

OphA:

Ophthalmic artery

DOA:

Dorsal ophthalmic artery

VOA:

Ventral ophthalmic artery

MMA:

Middle meningeal artery

MOA:

Meningo-ophthalmic artery

MLA:

Meningolacrimal artery

ACA:

Anterior cerebral artery

ACoA:

Anterior communicating artery

A1:

A1 tract of the anterior cerebral artery

A3:

A3 tract of the anterior cerebral artery

MCA:

Middle cerebral artery

M1:

M1 tract of the middle cerebral artery

PCoA:

Posterior communicating artery

SOF:

Superior orbital fissure

References

  1. Baltsavias G, Turk Y, Valavanis A (2012) Persistent ventral ophthalmic artery associated with supraclinoid internal carotid artery aneurysm: case report and review of the literature. J Neuroradiol 39:186–189. doi:10.1016/j.neurad.2011.08.002

    Article  PubMed  Google Scholar 

  2. Bergman RA, Thompson SA, Afifi AK, Saadeh FA (1988) Compendium of human anatomic variation catalog atlas and world literature. Urban & Schwarzenberg, Baltimore and Munich

    Google Scholar 

  3. Bervini D, Assaad N (2014) Ophthalmic artery arising from the anterior cerebral artery and concomitant internal carotid artery aneurysm: report of a case. J Neurol Surg A Cent Eur Neurosurg 75:p46. doi:10.1055/s-0034-1383776

    Google Scholar 

  4. Brucher J (1969) Origin of the ophthalmic artery from the middle meningeal artery. Radiology 93:51–52. doi:10.1148/93.1.51

    Article  CAS  PubMed  Google Scholar 

  5. Chanmugam PK (1936) Note on an unusual ophthalmic artery associated with other abnormalities. J Anat 70:580–582

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Dilenge D, Ascherl GF Jr (1980) Variations of the ophthalmic and middle meningeal arteries: relation to the embryonic stapedial artery. AJNR Am J Neuroradiol 1:45–54

    CAS  PubMed  Google Scholar 

  7. Fiore DL, Pardatscher K, Fiore D, Zuccarello M, Iraci G (1981) Persistent dorsal ophthalmic artery. Report of a case with associated fibromuscular hyperplasia of the extracranial internal carotid artery and multiple cerebral aneurysms. Neurochirurgia 24:106–108

    CAS  PubMed  Google Scholar 

  8. Fisher AG (1913) A case of complete absence of both internal carotid arteries, with a preliminary note on the developmental history of the stapedial artery. J Anat Physiol 48:37–46

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Frosen J, Tulamo R, Paetau A, Laaksamo E, Korja M, Laakso A, Niemela M, Hernesniemi J (2012) Saccular intracranial aneurysm: pathology and mechanisms. Acta Neuropathol 123:773–786. doi:10.1007/s00401-011-0939-3

    Article  PubMed  Google Scholar 

  10. Gabriele OF, Bell D (1967) Ophthalmic origin of the middle meningeal artery. Radiology 89:841–844. doi:10.1148/89.5.841

    Article  CAS  PubMed  Google Scholar 

  11. Grossman RI, Davis KR, Taveras JM (1982) Circulatory variations of the ophthalmic artery. AJNR Am J Neuroradiol 3:327–329

    CAS  PubMed  Google Scholar 

  12. Hamada J, Kitamura I, Kurino M, Sueyoshi N, Uemura S, Ushio Y (1991) Abnormal origin of bilateral ophthalmic arteries. Case report. J Neurosurg 74:287–289. doi:10.3171/jns.1991.74.2.0287

    Article  CAS  PubMed  Google Scholar 

  13. Hannequin P, Peltier J, Destrieux C, Velut S, Havet E, Le Gars D (2013) The inter-optic course of a unique precommunicating anterior cerebral artery with aberrant origin of an ophthalmic artery: an anatomic case report. Surg Radiol Anat: SRA 35:269–271. doi:10.1007/s00276-012-1028-6

    Article  PubMed  Google Scholar 

  14. Harvey JC, Howard LM (1945) Rare type of anomalous ophthalmic artery in a Negro. Anat Rec 92:87–90

    Article  Google Scholar 

  15. Hassler W, Zentner J, Voigt K (1989) Abnormal origin of the ophthalmic artery from the anterior cerebral artery: neuroradiological and intraoperative findings. Neuroradiology 31:85–87

    CAS  PubMed  Google Scholar 

  16. Hayashi N, Kubo M, Tsuboi Y, Nishimura S, Nishijima M, Ahmed Abdel-Aal M, Endo S (2007) Impact of anomalous origin of the ophthalmic artery from the middle meningeal artery on selection of surgical approach to skull base meningioma. Surg Neurol 68:568–571. doi:10.1016/j.surneu.2006.11.033

  17. Hayreh SS, Dass R (1962) The ophthalmic artery: I. Origin and intra-cranial and intra-canalicular course. Br J Ophthalmol 46:65–98

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Hiura A (1980) An anomalous ophthalmic artery arising from the middle meningeal artery. Anat Anz 147:473–476

    CAS  PubMed  Google Scholar 

  19. Honma Y, Ogawa T, Nagao S (1997) Angiographically occult anomalous ophthalmic artery arising from the anterior cerebral artery. Acta Neurochir 139:480–481

    Article  CAS  PubMed  Google Scholar 

  20. Horiuchi T, Tanaka Y, Kusano Y, Yako T, Sasaki T, Hongo K (2009) Relationship between the ophthalmic artery and the dural ring of the internal carotid artery. Clinical article. J Neurosurg 111:119–123. doi:10.3171/2008.11.JNS08766

    Article  PubMed  Google Scholar 

  21. Indo M, Oya S, Tanaka M, Matsui T (2014) High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation. J Neurosurg 120:93–98. doi:10.3171/2013.9.JNS131030

    Article  PubMed  Google Scholar 

  22. Islak C, Ogut G, Numan F, Cokyuksel O, Kuday C (1994) Persistent nonmigrated ventral primitive ophthalmic artery. Report on one case. J Neuroradiol 21:46–49

    CAS  PubMed  Google Scholar 

  23. Kam CK, Alvarez H, Lasjaunias P (2003) Double internal carotid origin of the ophthalmic artery with ruptured aneurysm of the posterior communicating artery. A case report. Interv Neuroradiol 9:383–388

    CAS  PubMed  Google Scholar 

  24. Keller HL (1961) Variations in the internal carotid artery, the middle meningeal artery and the ophthalmic artery in the carotid angiogram. Fortschr Geb Rontgenstr Nuklearmed 95:472–482

    Article  CAS  PubMed  Google Scholar 

  25. Konishi M, Kikuchi M, Saheki M (1988) An abnormal origin of the ophthalmic artery arising from the middle meningeal artery. Kaibogaku zasshi J Anat 63:70–77

    CAS  Google Scholar 

  26. Kyoshima K, Oikawa S, Kobayashi S (2000) Interdural origin of the ophthalmic artery at the dural ring of the internal carotid artery. Report of two cases. J Neurosurg 92:488–489. doi:10.3171/jns.2000.92.3.0488

    Article  CAS  PubMed  Google Scholar 

  27. Lasjaunias P, Berenstein A, ter Brugge K (2001) Clinical vascular anatomy and variations, vol 1. Surgical neuroangiography. Springer, Berlin

    Book  Google Scholar 

  28. Lasjaunias P, Moret J, Mink J (1977) The anatomy of the inferolateral trunk (ILT) of the internal carotid artery. Neuroradiology 13:215–220

    Article  CAS  PubMed  Google Scholar 

  29. Li Y, Horiuchi T, Yako T, Ishizaka S, Hongo K (2011) Anomalous origin of the ophthalmic artery from the anterior cerebral artery. Neurol Med Chir 51:579–581

    Article  Google Scholar 

  30. Liu Q, Rhoton AL Jr (2001) Middle meningeal origin of the ophthalmic artery. Neurosurgery 49:401–406, discussion 406–407

    CAS  PubMed  Google Scholar 

  31. Lombardi G (1969) Ophthalmic artery anomalies. Ophthalmologica 157:321–327

    Article  CAS  PubMed  Google Scholar 

  32. Louw L (2014) Different ophthalmic artery origins: embryology and clinical significance. Clin Anat. doi:10.1002/ca.22470

    Google Scholar 

  33. Louw L, Steyl J, Loggenberg E (2014) Imaging of dual ophthalmic arteries: identification of the central retinal artery. J Clin Imaging Sci 4:40. doi:10.4103/2156-7514.137833

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lowrey LG (1915) Anomaly of the circle of Willis, due to absence of the right internal carotid artery. Anat Rec 10

  35. Matsumura Y, Nagashima M (1999) Anatomical variations in the origin of the human ophthalmic artery with special reference to the cavernous sinus and surrounding meninges. Cells Tissues Organs 164:112–121

    Article  CAS  PubMed  Google Scholar 

  36. Mazighi M, Porter PJ, Rodesch G, Alvarez H, Aghakhani N, Lasjaunias P (2002) Vascular anomalies and the risk of multiple aneurysms development and bleeding. Interv Neuroradiol 8:15–20

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Morandi X, Le Bourdon E, Darnault P, Brassier G, Duval JM (1998) Unusual origin of the ophthalmic artery and occlusion of the central retinal artery. Surg Radiol Anat 20:69–71

    Article  CAS  PubMed  Google Scholar 

  38. Musgrove J (1893) Origin of ophthalmic artery from middle meningeal. J Anat Physiol 27:279–281

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Naeini RM, De J, Satow T, Benndorf G (2005) Unilateral agenesis of internal carotid artery with ophthalmic artery arising from posterior communicating artery. Am J Roentgenol 184:571–573. doi:10.2214/ajr.184.2.01840571

    Article  Google Scholar 

  40. Nakagawa T, Tanabe S, Sato O (1982) Anomalous ophthalmic artery-case reports and review of literature (author's transl). No to shinkei. Brain Nerve 34:405–413

    CAS  PubMed  Google Scholar 

  41. Nakata H, Iwata Y (1987) Agenesis of the left internal carotid artery with an ophthalmic artery arising from the posterior communicating artery. No shinkei geka Neurol Surg 15:57–62

    CAS  Google Scholar 

  42. Namba K, Nemoto S (2013) Double ophthalmic artery visualized with new technology. Neuroradiol J 26:371–372

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Ogawa T, Miyauchi T, Kato T, Tamakawa Y (1990) Internal carotid origin of double ophthalmic arteries. Neuroradiology 32:508–510

    Article  CAS  PubMed  Google Scholar 

  44. Onerci M, Gumus K, Cil B, Eldem B (2005) A rare complication of embolization in juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol 69:423–428. doi:10.1016/j.ijporl.2004.10.015

    Article  PubMed  Google Scholar 

  45. Osborn AG (1999) Diagnostic cerebral angiography. Lippincott Williams and Wilkins, Philadelphia

    Google Scholar 

  46. Padget DH (1948) The development of the cranial arteries in the human embryo … with five plates, etc. Contribut Embryol 32:212

    Google Scholar 

  47. Parlato C, di Nuzzo G, Luongo M, Tortora F, Briganti F (2011) Anatomical variant of origin of ophthalmic artery: case report. Surg Radiol Anat 33:275–278. doi:10.1007/s00276-010-0745-y

    Article  CAS  PubMed  Google Scholar 

  48. Perrini P, Cardia A, Fraser K, Lanzino G (2007) A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses. J Neurosurg 106:142–150. doi:10.3171/jns.2007.106.1.142

    Article  PubMed  Google Scholar 

  49. Picard L, Vignaud J, Lombardi G, Roland J (1975) Radiological anatomy of the origin of the ophthalmic artery. Mod Probl Ophthalmol 14:164–169

    CAS  PubMed  Google Scholar 

  50. Pretterklieber ML, Schindler A, Krammer EB (1994) Unilateral persistence of the dorsal ophthalmic artery in man. Acta Anat 149:300–305

    Article  CAS  PubMed  Google Scholar 

  51. Priman J, Christie DH (1959) A case of abnormal internal carotid artery and associated vascular anomalies. Anat Rec 134:87–95

    Article  CAS  PubMed  Google Scholar 

  52. Rhoton AL Jr (2002) The supratentorial arteries. Neurosurgery 51:S53–120

    PubMed  Google Scholar 

  53. Rosen CL, Ammerman JM, Sekhar LN, Bank WO (2002) Outcome analysis of preoperative embolization in cranial base surgery. Acta Neurochir 144:1157–1164. doi:10.1007/s00701-002-0965-y

    Article  CAS  PubMed  Google Scholar 

  54. Sade B, Tampieri D, Mohr G (2004) Ophthalmic artery originating from basilar artery: a rare variant. AJNR Am J Neuroradiol 25:1730–1731

    PubMed  Google Scholar 

  55. Schumacher M, Wakhloo AK (1994) An orbital arteriovenous malformation in a patient with origin of the ophthalmic artery from the basilar artery. AJNR Am J Neuroradiol 15:550–553

    CAS  PubMed  Google Scholar 

  56. Shima K, Kawasaki T, Shimizu A, Takiguchi H, Chigasaki H (1995) An ophthalmic artery occlusion after a craniotomy using the pterional approach: a report of three cases, one resulting in blindness. Jpn J Neurosurg (Tokio) 4:163–169

    Google Scholar 

  57. Shimada K, Kaneko Y, Sato I, Ezure H, Murakami G (1995) Classification of the ophthalmic artery that arises from the middle meningeal artery in Japanese adults. Okajimas Folia Anat Jpn 72:163–176

    Article  CAS  PubMed  Google Scholar 

  58. Tanaka M (2009) Persistent primitive dorsal ophthalmic artery associated with paraclinoid internal carotid artery aneurysm. J Neuroendovasc Ther 3:39–41

    Article  Google Scholar 

  59. Uchino A, Saito N, Kurita H, Ishihara S (2013) Double ophthalmic arteries arising from the internal carotid artery. Surg Radiol Anat: SRA 35:173–175. doi:10.1007/s00276-012-1005-0

    Article  PubMed  Google Scholar 

  60. Uchino A, Saito N, Takahashi M, Kozawa E, Mizukoshi W, Nakajima R, Okano N (2013) Persistent dorsal ophthalmic artery and ophthalmic artery arising from the middle meningeal artery diagnosed by MR angiography at 3 T. Surg Radiol Anat 35:775–782. doi:10.1007/s00276-013-1085-5

    Article  PubMed  Google Scholar 

  61. Uchino A, Sawada A, Takase Y, Kudo S (2003) MR angiography of anomalous branches of the internal carotid artery. AJR Am J Roentgenol 181:1409–1414. doi:10.2214/ajr.181.5.1811409

    Article  PubMed  Google Scholar 

  62. Watanabe A, Hirano K, Ishii R (1996) Dural caroticocavernous fistula with both ophthalmic arteries arising from middle meningeal arteries. Neuroradiology 38:806–808

    Article  CAS  PubMed  Google Scholar 

  63. Weinberg PE, Patronas NJ, Kim KS, Melen O (1981) Anomalous origin of the ophthalmic artery in a patient with amaurosis fugax. Arch Neurol 38:315–317

    Article  CAS  PubMed  Google Scholar 

  64. Willinsky R, Lasjaunias P, Berenstein A (1987) Intracavernous branches of the internal carotid artery (ICA). Comprehensive review of their variations. Surg Radiol Anat: SRA 9:201–215

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Francesco Belotti, Marco Ferrari, Marco Angelo Cocchi, Davide Lancini, Barbara Buffoli, Manfred Tschabitscher & Luigi Fabrizio Rodella

  2. Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy

    Francesco Doglietto & Marco Maria Fontanella

  3. ENT surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Piero Nicolai

  4. Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Roberto Maroldi

Authors
  1. Francesco Belotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Doglietto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Angelo Cocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Davide Lancini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Barbara Buffoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Piero Nicolai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marco Maria Fontanella
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Roberto Maroldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Manfred Tschabitscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Luigi Fabrizio Rodella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Doglietto.

Additional information

Comments

Florian Roser, Abu Dhabi, United Arab Emirates

The authors should be commemorated for their excellent description of an unusual case of anomalous origin of the ophthalmic artery. Their passion for the scientific detail is demonstrated by the use of several tools not only to visualize but to gain insights into histology and flow dynamics. This could serve as a role model for anatomical education, to be prepared during dissection and eventually apply tools to further elaborate on the findings. Their preparedness gives the reader the unique opportunity to participate.

As pointed out, the course of the ophthalmic artery varies and it is of crucial importance for the neurosurgeon to know about these possible aberrations to intraoperatively judge further management. In the presented case, the anomalous opthalmic artery might have contributed to the intraorbital blood flow to a lesser extent than usual and could have been compromised without causing visual deficit. This is in contrary to the cited publications where the anomalous course of the ophthalmic artery was the sole contributor to optic nerve blood flow.

The association of anatomical variants of intracranial arteries and formation of aneurysm is a well-known fact; with this report, the authors provide evidence that the anomaly is not only restricted to the visible aberration of its anatomical course, but that the adjacent vascular network does show texture changes in their vessel walls leading to possible aneurysm formation. The clinical experience especially in medial ICA aneurysms taught us that often the pathology extends far beyond the actual aneurysm.

Florian Ebner, Tuebingen, Germany

Belotti et al. deal in this well-written article with a very important topic for microsurgery in the parasellar region: anatomical variations of the ophthalmic artery. The authors detected during anatomical dissection of a fresh-frozen, silicon-injected head of a 81-year-old Caucasian donor, the anomalous origin of the ophtalmic artery from the anterior cerebral artery. They elaborated this observation meticulously from a transnasal and transcranial perspective and performed a radiologic analysis and extensive histological study of the specimen’s internal carotid arteries as well as a corrosion casting analysis.

Two aspects are of particular surgical interest, in my opinion: First, the intraorbital anastomosis with the meningoophtalmic artery, emphasizing the potential role of the middle meningeal artery in vascularizing optic nerve and retina; second, the apparent correlation between anomalous ophthalmic arteries and ICA aneurysms. Both issues are of clinical importance when dealing with vascular or neoplastic pathologies in the parasellar region.

This paper is an excellent example on how important is a meticulous preoperative and intraoperative assessment of individual anatomy. Variations have to be recognized and respected in order to attain optimal surgical results. Belotti et al. demonstrate once again relevance and up-to-dateness of anatomical studies in modern neurosurgery.

Francesco Belotti and Marco Ferrari contributed equally to the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Belotti, F., Ferrari, M., Doglietto, F. et al. Ophthalmic artery originating from the anterior cerebral artery: anatomo-radiological study, histological analysis, and literature review. Neurosurg Rev 39, 483–493 (2016). https://doi.org/10.1007/s10143-016-0715-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-016-0715-x

Keywords

Search

Navigation