Tian J. Unexpected ocular morbidity after middle meningeal artery embolization: Lessons learned from a case of anastomotic-related diplopia. World J Clin Cases 2025; 13(28): 109679 [DOI: 10.12998/wjcc.v13.i28.109679]
Corresponding Author of This Article
Ju Tian, Department of Burns and Plastic Surgery, Zhongshan City People’s Hospital, No. 2 Sunwen East Road, Zhongshan 528400, Guangdong Province, China. tian-ju@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Unexpected ocular morbidity after middle meningeal artery embolization: Lessons learned from a case of anastomotic-related diplopia
Ju Tian
Ju Tian, Department of Burns and Plastic Surgery, Zhongshan City People’s Hospital, Zhongshan 528400, Guangdong Province, China
Author contributions: Tian J conceptualized and designed the overarching framework and structure of the manuscript. In addition, Tian J actively participated in drafting and revising the content, creating the illustrations, and conducting a comprehensive review of the pertinent literature.
Conflict-of-interest statement: Dr. Tian has nothing to disclose for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ju Tian, Department of Burns and Plastic Surgery, Zhongshan City People’s Hospital, No. 2 Sunwen East Road, Zhongshan 528400, Guangdong Province, China. tian-ju@163.com
Received: May 18, 2025 Revised: June 2, 2025 Accepted: July 17, 2025 Published online: October 6, 2025 Processing time: 81 Days and 17.8 Hours
Abstract
Middle meningeal artery embolization (MMAE) has revolutionized chronic subdural hematoma management, yet procedural risks persist due to anatomical variability. We analyze a case report by Zhao et al describing transient diplopia caused by inadvertent embolization of the lacrimal artery via a dynamic middle meningeal–ophthalmic anastomosis. This correspondence advances three critical innovations in MMAE safety. First, intraoperative anastomotic unmasking—exposing occult middle meningeal-ophthalmic collaterals during particle injection—reveals dynamic vascular behavior missed by preoperative angiography, underscoring the need for adaptive imaging protocols. Second, hybrid embolization (liquid agents for proximal occlusion + particles for distal control) balances precision and safety, reducing reflux risks compared to monotherapy. Third, a 108-day follow-up establishes a benchmark for functional recovery, challenging assumptions about irreversible cranial nerve injuries and emphasizing structured postprocedural care. Collectively, these findings advocate for procedural agility, multimodal embolic strategies, and sustained rehabilitation to optimize MMAE outcomes while minimizing iatrogenic harm.
