Identification of middle meningeal artery confluence point in 3D CT scan images of Filipinos as pre-operative planning for management of chronic subdural hematoma: A cross-sectional morphometric study

OBJECTIVE: Chronic subdural hematoma (CSDH) commonly affects older adults and remains associated with recurrence despite surgical evacuation. Coagulation of middle meningeal artery (MMA) during burr-hole drainage may be useful where MMA embolization is unavailable, however reliable external landmarks for MMA localization are poorly defined. This study aimed to identify the MMA confluence point on 3D cranial CT scans of elderly Filipino patients and define its relationship to external cranial landmarks to support pre-operative planning. METHODS: A retrospective cross-sectional morphometric study was performed using plain cranial CT scans of patients aged ≥65 years from 2019 to 2023. Scans with intact calvarial anatomy and adequate visualization of MMA groove were included. Threedimensional reconstructions were generated, and bilateral distances from lateral canthus, external auditory canal, and canthomeatal line to MMA confluence point were measured. Analyses were performed by sex and laterality (p