Bilateral persistent stapedial arteries associated with unilateral moyamoya disease: a particular anatomic variant

Purpose: The persistence of the stapedial artery is a rare vascular variant that could explain the origin of the middle meningeal artery from the petrous segment of the internal carotid artery. The anatomic variations are illustrated and a summary of the possible hypothesis of the origin of the middle meningeal artery from the internal carotid artery is discussed, analysing the embryological works of the Carnegie Institute and the vascular development of the middle meningeal. Methods and results: The authors present a young patient showing a particular vascular variant on diagnostic imaging. These showed a bilateral internal carotid artery that gives origin of the middle meningeal artery in a patient affected by moyamoya disease. A literature review was performed to analyze the particular variant of the radiologic anatomy. Conclusion: The internal carotid artery origin of the middle meningeal artery is a wonderful anatomic variant that permits to understand the complex embryological development and then involution of the stapedial artery.