Supraorbital artery: Anatomical variations and neurosurgical applications

Abstract

Background: The supraorbital artery (SOA) originates from the ophthalmic artery in a superomedial aspect of the orbit, exiting through the supraorbital groove to emerge onto the forehead. The SOA has important neurosurgical considerations regarding different approaches and bypasses. The SOA is poorly described in the standard anatomical textbooks. Therefore, we present this article to describe the anatomical variations of the SOA and their implications on the neurosurgical field.

Methods: We conducted a literature review in PubMed and Google Scholar databases to review the existing literature describing the SOA anatomy and its neurosurgical applications.

Results: While reading the available articles and original works regarding SOA, we identified 22 studies that discuss the SOA. We noticed the anatomical variations of the SOA in terms of origin, course, diameter, branches, depth, and distance in relation to the midline and vertical glabellar line. We also discussed certain applications of SOA and its importance in neurosurgical approaches, bypass, photoplethysmography, aneurysms, and reconstruction of cranial fossa defects.

Conclusion: The variable anatomy of the SOA has a paramount impact on performing different neurosurgical approaches. Therefore, cadaveric studies of the SOA are important to explore potential methods for the preservation of the artery in different neurosurgical applications.

Keywords: Anatomical variation; Neuroanatomy; Supraorbital artery.

Figure 1:

Anatomical variation of superficial and deep branches of SOA. On the right (Rt) hemi-forehead, SOA divides into superficial and a deep branches after it exits the supraorbital foramen. On the left (Lt) hemiforehead, deep branch of SOA extends superficially and superolaterally from the supraorbital notch; then, it pierces the frontalis muscle forming the superficial branch. SOA: Supraorbital artery.

Figure 2:

The left (Lt) hemi-forehead view demonstrates the terminal branches of the supraorbital artery. This includes the superficial branches on the left hemi-forehead: brow branch (BB) and superficial vertical branch (SVB), as well as the deeper branches: medial branch (MB), oblique branch (OB), vertical branch (VB), and lateral rim branch (LRB).

Figure 3:

(a) Illustration of a skull base reconstruction procedure employing a pericranial flap derived from the supraorbital artery. This procedure involves making a bicoronal skin incision and carefully peeling forward the skin and galea-frontalis layers. (b) This step in the process involves carefully separating the pericranium from the galea-frontalis layer. The pericranium, harvested as a flap, is a vital component for the subsequent stages of the skull base reconstruction. This flap provides the necessary coverage and support for the newly reconstructed area. (c) The image depicts a frontal craniotomy procedure, a crucial step in the skull base reconstruction process. This involves craniotomy of the frontal bone to access the underlying structures for repair and reconstruction. (d) This image illustrates the crucial step of introducing the pericranial flap into the frontal cranial cavity. The flap is skillfully maneuvered to reconstruct the defect in the anterior cranial fossa, thereby restoring the anatomical integrity of the skull base.