An atypical stapedial artery.

The persistence of the stapedial artery is a rare vascular anomaly. It is mostly asymptomatic but sometimes cause conductive hearing loss, pulsatile tinnitus, or vertigo. The estimated prevalence of this rare postembryonic persistence ranged from 0.02% to 0.48%. Four different anatomical forms have been identified, and their preoperative diagnostic is essential. We report the case of an incidental discovery of pharyngo-hyo-stapedial artery, the most uncommon form of persistent stapedial artery. Its per-operative finding has become rare because tomodensitometry is performed in case of conductive hearing loss. The continuous improvement of imagery resolution will probably help to revise the incidence of this malformation.

Persistent stapedial artery in PHACE syndrome.

INTRODUCTION: PHACE syndrome is characterized by posterior fossa malformations, haemangioma, arterial anomalies, coarctation of the aorta, and eye abnormalities. CASE REPORT: We present the case of a 6-year-old girl followed since birth for PHACE syndrome and left hemifacial haemangioma, who presented with left hearing loss. Computed tomography scan showed left persistent stapedial artery (PSA). DISCUSSION: Two types of arterial anomalies may be observed in PHACE syndrome: persistence of embryonic arteries and anomalies of cerebral arteries. PSA can be observed in the context of PHACE syndrome. Children with PHACE syndrome require regular audiometric follow-up to detect hearing loss and avoid its consequences on speech and language development.

Two Consecutive Cases of Persistent Stapedial Artery Managed With a Carbon Dioxide Laser.

OBJECTIVE: (1) Discuss the presentation and management of persistent stapedial artery (PSA) discovered incidentally during cholesteatoma surgery. (2) Review use of carbon dioxide (CO2) laser for treatment of PSA in the setting of chronic ear disease. PATIENTS: Two consecutive patients with PSA and primary acquired cholesteatoma. INTERVENTION(S): Tympanomastoidectomy using a canal wall reconstruction technique. MAIN OUTCOME MEASURE(S): Surgical healing, collateral damage to surrounding anatomy, and postoperative hearing. RESULTS: Persistent stapedial artery was detected incidentally in 2 patients, manifesting with heavy pulsatile bleeding arising during dissection of mesotympanic cholesteatoma. Preoperative computed tomography scans demonstrated absent foramen spinosum but no other aberrant vascular anatomy. Using CO2 laser, the PSAs were ablated and controlled, allowing complete resection of cholesteatoma and successful completion of the procedure. In both patients, surrounding anatomical structures suffered no iatrogenic injury. Postoperatively, no significant complications occurred. To date, neither patient has demonstrated evidence of recidivistic cholesteatoma. CONCLUSIONS: A CO2 laser can be useful for managing a PSA in the setting of chronic ear disease.

Persistent stapedial artery with stapes ankylosis.

The persistent stapedial artery (PSA) is a very rare, congenital, vascular anomaly. It presents as a pulsatile middle ear mass and sometimes causes conductive hearing loss. The diagnosis of the presence of a PSA is always accidental, because it is so rare and difficult to predict. CT findings include the absence of the foramen spinosum and a soft-tissue prominence in the region of the tympanic segment of the facial nerve. The risks of surgery include facial palsy, hemiplegia caused by coagulation of the PSA, and bleeding due to injury of the carotid artery during surgery in cases of aberrant internal carotid. In this article we report a case of PSA with stapes ankylosis for which we performed malleus-stapedotomy using a Teflon wire piston. We did not coagulate the PSA. Nevertheless the PSA attached to the prosthesis, the patient presented significant improvement in hearing level and had no complaint of pulsating tinnitus. Thus, we have shown that attachment of the prosthesis to the PSA does not necessarily disturb improvement of hearing level after malleus-stapedotomy for otosclerosis with PSA. Based on our experience, many cases can be treated by stapedotomy using a prosthesis and without coagulating the PSA.

Three-dimensional temporal bone reconstruction from histological sections.

OBJECTIVE: To produce a high-resolution, three-dimensional temporal bone model from serial sections, using a personal computer. METHOD: Digital images were acquired from histological sections of the temporal bone. Image registration, segmentation and three-dimensional volumetric reconstruction were performed using a personal computer. The model was assessed for anatomical accuracy and interactivity by otologists. RESULTS: An accurate, high-resolution, three-dimensional model of the temporal bone was produced, containing structures relevant to otological surgery. The facial nerve, labyrinth, internal carotid artery, jugular bulb and all of the ossicles were seen (including the stapes footplate), together with the internal and external auditory meati. Some projections also showed the chorda tympani nerve. CONCLUSION: A high-resolution, three-dimensional computer model of the complete temporal bone was produced using a personal computer. Because of the increasing difficulty in procuring cadaveric bones, this model could be a useful adjunct for training.

Persistent stapedial artery: a congenital anomaly to know.

Persistent stapedial artery, one of the rare arterial congenital anomalies of the middle ear, is important to know due to its possible clinical repercussions. Ignoring its existence may lead to complications during surgery of the middle ear (notably hemorrhage). Exploration of the vascular malformation is rendered possible via high-definition computed tomography (CT) imaging of the petrous bones, which reveals the frequent bilaterality of this anatomical variation as well as the presence of associated anomalies. We report on two cases of persistent stapedial artery discovered during CT scan explorations.

[Persistent stapedial artery with otosclerosis]. / Artère stapédienne persistante et ankylose stapédovestibulaire.

OBJECTIVES: A persistent stapedial artery is a rare vascular malformation. This diagnosis is based on CT scan and intraoperative findings. MATERIAL AND METHODS: The case of a 19-year-old woman with a persistent stapedial artery found during stapes surgery is reported. This vascular malformation was explored with a CT scan showing the bilaterality of this anatomical variation and signs of associated otosclerosis. RESULTS: This malformation was successfully coagulated with laser allowing the stapedotomy to be completed. CONCLUSIONS: A persistent stapedial artery is not a contraindication to stapedotomy because it can be safely coagulated during the same procedure.

Anomalies of the middle and inner ear.

The development of the middle and inner ear highlights the intricacy of embryology. As early as 3 weeks after fertilization, the inner ear begins taking form. This process, along with development of the middle ear, continues throughout gestation. At birth, the middle ear, inner ear, and associated structures are almost adult size. An understanding of the embryologic development of the ear serves as a foundation for evaluating and managing congenital malformations of these structures. The focus of this article is the normal, abnormal, and arrested development of the middle and inner ear, with a clinical emphasis on malformed middle and inner ear structures and a discussion of associated syndromes.

Bilateral aberrant internal carotid arteries with bilateral persistent stapedial arteries and bilateral duplicated internal carotid arteries.

A 5-year-old boy was evaluated for a left retrotympanic mass found at otoscopy. Subsequent petrous bone CT and MR angiographic examinations demonstrated bilateral aberrant internal carotid, bilateral stapedial artery persistence, and bilateral duplicated internal carotid arteries. Imaging findings and their clinical relevance are discussed. A second case of unilateral aberrant internal carotid artery with a persistent stapedial artery is included for comparison.

Persistent stapedial artery: CT findings.

CT of a patient with conductive hearing loss showed a small vascular structure leaving the carotid canal and passing through the stapes to join the facial nerve canal. The small bony channel paralleled the anterior tympanic segment of the facial nerve, continuing beyond the geniculate ganglion into the middle cranial fossa. Otoendoscopic photography documented the presence of a persistent stapedial artery.

Anomalous vessel in the middle ear: the role of CT and MR angiography.

An 8-year-old child was examined because of conductive hearing loss with a retrotympanic mass on otoscopy. CT and MR angiography showed a large inferior tympanic artery traversing the hypotympanum and joining a thin, irregular internal carotid artery with a normal middle meningeal artery. These investigations, coupled with knowledge of the embryological development allowed a diagnosis of a complex vascular anomaly in the middle ear and avoided potential surgical complications.

Persistent stapedial artery preventing successful cochlear implantation: a case report.

A case of persistent stapedial artery preventing cochlear implantation is described and the literature relating to this congenital anomaly is reviewed. The computed tomographic features of the artery are illustrated, and it is recommended that preoperative computed tomography be specifically screened for this anomaly.

Prevalence of facial canal dehiscence and of persistent stapedial artery in the human middle ear: a report of 1000 temporal bones.

A total of 1000 temporal bones were used to study the prevalence of facial canal dehiscence and of persistent stapedial artery in detail. Of the temporal bones studied, 560 (56%) contained at least one facial canal dehiscence. There was a 76.3% prevalence of bilaterality of this canal wall gap. The most common site of dehiscence was the oval window area. The concept of microdehiscence of the facial canal is introduced. One third of the temporal bones observed had a microdehiscence of the facial canal, usually located at the oval window area (74.9%) and found bilaterally 40% of the time. The authors found a 0.48% prevalence (5 out of 1045) of persistent stapedial artery. This is the first histological study of temporal bones to report a prevalence of this vascular anomaly.

Stapedial artery supplying sphenoid wing meningioma: case report.

A 46-year-old woman presented complaining of resting tremor of the right arm and attacks of inappropriate crying and laughing. Computed tomography and magnetic resonance imaging of the head revealed a large left sphenoid wing meningioma. Preoperative cerebral angiography demonstrated a persistent stapedial artery, terminating as a middle meningeal artery which was the main blood supply to the tumour.