Transorbital Endoscopic Ligation of the Middle Meningeal Artery

The middle meningeal artery is implicated in numerous neurovascular phenomena, including intracranial hemorrhage, dural arteriovenous fistula, aneurysms, and pseudoaneurysms. Vascular control of the middle meningeal artery is now being utilized in the setting of chronic subdural hematoma or for devascularization of certain brain tumors. When endovascular techniques are unavailable, the surgeon may consider traditional open techniques for vessel management. The emergence of transorbital neuroendoscopic surgery provides a novel corridor to address skull base pathology of the infratemporal fossa. In this chapter, we describe the clinical nuances and step-by-step dissection for transorbital endoscopic middle meningeal artery ligation. The surgeon should be cognizant of the benefits, risks, and limitations of this technique and tailor the approach to the individual patient.