{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:38:11Z","timestamp":1792427891253,"version":"4.5.0"},"reference-count":23,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Purpose: Meningo-ophthalmic and orbitomeningeal arterial communications comprise route-specific relationships between the middle meningeal artery (MMA) and the ophthalmic or orbital arterial system. Their recognition is relevant to middle meningeal artery embolization because orbital or ophthalmic collateral pathways may create routes for non-target embolization. This systematic review aimed to synthesize the prevalence and anatomical patterns of these communications, using quantitative pooling only where the anatomical definition and denominator were sufficiently coherent. Methods: This systematic review and meta-analysis were conducted according to PRISMA 2020 principles and registered in PROSPERO (CRD420261361050). Eligible studies were original human cadaveric anatomical, angiographic, or radiological investigations reporting MMA-ophthalmic or MMA-orbital arterial relationships. After the closure of the full-text retrieval audit, studies and extracted rows were audited by anatomical family, unit of analysis, numerator, denominator, and independence. No global pooled prevalence was calculated across anatomical families. When family-specific pooling was methodologically defensible, proportions were synthesized using logit transformation, restricted maximum likelihood random-effects models, and Hartung-Knapp confidence intervals. Results: Database searches identified 558 records. After removal of 228 duplicates, 330 records were screened, and 285 were excluded by title and abstract. Forty-five reports were sought for retrieval; 10 were not retrieved or were not available as assessable full-text reports after retrieval auditing. Thirty-five full-text reports were assessed; thirteen were excluded for reasons, and three were duplicate reports at the full-text stage. Nineteen studies were included in the qualitative synthesis, and 12 contributed independent data to the final R-ready matrix. MMA arising from the ophthalmic artery was uncommon, with a pooled prevalence of 0.03 (95% CI 0.01 to 0.13; I2 = 75.9%). After excluding the clinically selected chronic subdural hematoma subgroup, the estimate was 0.02 (95% CI 0.01 to 0.06; I2 = 7.7%). The meningolacrimal\/lacrimal-MMA route yielded an exploratory pooled proportion of 0.45 (95% CI 0.09 to 0.86; I2 = 95.9%), with substantial anatomical and methodological heterogeneity. Conclusions: The available evidence supports route-specific synthesis rather than a single global prevalence estimate. MMA arising from the ophthalmic artery appears uncommon but procedurally important; however, this estimate should be interpreted as a route-specific estimate across eligible angiographic\/anatomical series rather than as a universal anatomical prevalence. Meningolacrimal and lacrimal-MMA routes are frequently described, but their prevalence remains difficult to generalize because detection methods, populations, and denominators differ across studies. Future anatomical and angiographic reports should standardize route definitions, laterality, unit of analysis, and denominator reporting to improve prevalence estimation and procedural safety interpretation.<\/jats:p>","DOI":"10.3390\/neurolint18070128","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:05:38Z","timestamp":1783325138000},"page":"128","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Route-Specific Meningo-Ophthalmic and Orbitomeningeal Communications Relevant to Middle Meningeal Artery Embolization: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7697-419X","authenticated-orcid":false,"given":"Alejandro","family":"Bruna-Mejias","sequence":"first","affiliation":[{"name":"Departamento de Ciencias y Geograf\u00eda, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valpara\u00edso 2360072, Chile"},{"name":"Escuela de Medicina, Facultad de Medicina, Universidad Andr\u00e9s Bello, Vi\u00f1a del Mar 2520000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loreto","family":"Paez-Allendes","sequence":"additional","affiliation":[{"name":"Departamento de Ciencias y Geograf\u00eda, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valpara\u00edso 2360072, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Perez-Lira","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Facultad de Medicina, Universidad Andr\u00e9s Bello, Vi\u00f1a del Mar 2520000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Santander-Chavez","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Facultad de Medicina, Universidad Andr\u00e9s Bello, Vi\u00f1a del Mar 2520000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathis","family":"Miranda-Schoen","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Facultad de Medicina, Universidad Andr\u00e9s Bello, Vi\u00f1a del Mar 2520000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Jos\u00e9","family":"Valenzuela-Fuenzalida","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Facultad de Medicina, Universidad Andr\u00e9s Bello, Vi\u00f1a del Mar 2520000, Chile"},{"name":"Departamento de Ciencias Qu\u00edmica y Biol\u00f3gicas, Facultad de Ciencias de la Salud, Universidad Bernardo O\u2019Higgins, Santiago 8370993, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda P.","family":"Moya","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad Aut\u00f3noma de Chile, Santiago 8910060, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Oyanedel-Amaro","sequence":"additional","affiliation":[{"name":"Faculty of Health and Social Sciences, University of the Americas, Santiago 8370040, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6497-3480","authenticated-orcid":false,"given":"Gloria","family":"Cifuentes-Suazo","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Carrera de Odontolog\u00eda, Universidad Cat\u00f3lica de la Sant\u00edsima Concepci\u00f3n, Av. Alonso de Ribera 2850, Concepci\u00f3n 4090541, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1781-062X","authenticated-orcid":false,"given":"Mathias","family":"Orellana-Donoso","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile"},{"name":"Facultad de Medicina y Ciencia, Universidad San Sebasti\u00e1n, Lota 2465, Santiago 7510157, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan J.","family":"Cabezas-Salgado","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad Cat\u00f3lica del Maule, Talca 3460000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristopher","family":"Blackwood-Espinoza","sequence":"additional","affiliation":[{"name":"Escuela de Ciencias de la Salud, Universidad Vi\u00f1a del Mar, Vi\u00f1a del Mar 2520000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2599-8474","authenticated-orcid":false,"given":"Juan","family":"Sanchis-Gimeno","sequence":"additional","affiliation":[{"name":"GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/BF00344246","article-title":"Internal carotid origins of the middle meningeal artery: The ophthalmic-middle meningeal and stapedial-middle meningeal arteries","volume":"7","author":"McLennan","year":"1974","journal-title":"Neuroradiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/BF00341426","article-title":"Maxillary artery blood supply to the orbit: Normal and pathological aspects","volume":"9","author":"Lasjaunias","year":"1975","journal-title":"Neuroradiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"142","DOI":"10.3171\/jns.2007.106.1.142","article-title":"A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses","volume":"106","author":"Perrini","year":"2007","journal-title":"J. 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