Middle Meningeal Artery Collateralization Patterns and Influencing Factors in Pediatric Moyamoya

Introduction: The middle meningeal artery (MMArt) is considered to be an important collateral in moyamoya angiopathy; however, an in-depth analysis of the underlying mechanisms directing this collateral formation is missing. The aim of this study was to analyze patterns of activation of MMArt in pediatric patients along with identifying factors influencing these collateral pathways. Methods: Retrospective clinical and angiographic data of a pediatric moyamoya cohort managed at a single center were analyzed. Angiographic staging, MMArt activation, and collateral supply via posterior cerebral artery (PCA) were evaluated on cerebral angiograms. Stroke burden was evaluated using cerebral MRI. Associations with angiographic staging, stroke burden, and PCA collateral supply were determined. Conclusion: The MMArt serves as a crucial collateral in pediatric moyamoya, particularly to the frontal lobes. Increased MMArt activation is seen in advanced angiopathy with prolonged disease duration and PCA-derived collaterals. Stroke burden and angiopathy subtype do not appear to influence MMArt activation.