Anatomic and Angiographic Analyses of Ophthalmic Artery Collaterals in Moyamoya Disease

Illustrative case 2. A, Lateral ICA angiogram with the ophthalmic artery (triangles) having an anterior ethmoidal artery anastomosis by a falcine artery (arrows) with retrograde perfusion of an anterior cerebral artery branch (asterisks). The same angiogram as shown in A in an oblique view. C, Parenchymal time of the angiogram of A and B that shows the complete perfusion of the frontal lobe. D, An example of a duro-pial anastomosis from the right middle meningeal artery via the falcine arteries (arrows) to the left cingulate gyrus. E, The presence of retrograde perfusion of the pericallosal artery (arrowheads) on a lateral vertebral artery angiogram by a callosal circle (arrows). F, Lateral ICA angiogram with complete occlusion of the supraclinoidal segment of the ICA and posterior ethmoidal artery anastomosis (arrowheads). Note the presence of an ICA origin of the middle meningeal artery (asterisk).

Illustration showing the 4 systems of arterial collaterals to supply the ACA territories. A, Anterior ethmoidal artery anastomosis (1: ophthalmic artery; 2: anterior ethmoidal artery; 4: anterior falcine artery). B, Posterior ethmoidal artery anastomosis (1: ophthalmic artery; 3: posterior ethmoidal artery; 5: orbitofrontal artery). C, Callosal circle. D, Leptomeningeal anastomosis (posterior cerebral artery–ACA). E, Duro-pial anastomosis from a branch of the middle meningeal artery.