Persistent stapedial artery
| Persistent stapedial artery | |
|---|---|
 | |
| The main branches of the carotid arteries, the stapedial artery is visible in the top right in grey. | |
| Specialty | Otolaryngology, angiology |
| Symptoms | Pulsatile tinnitus, conductive hearing loss |
| Usual onset | From birth |
| Diagnostic method | CT scan, angiography, radiography |
| Treatment | Coagulation, hearing aids |
| Frequency | Extremely rare |
A persistent stapedial artery (PSA) is a rare anomaly in human anatomy where the stapedial branch of posterior auricular artery, or simply stapedial artery, remains within the ear of a fetus after the first ten weeks of pregnancy. Whilst not problematic for the majority of people with the anomaly, it can cause difficulties with hearing.
Signs and symptoms
Most cases of PSA cases remain asymptomatic for a person's life;[1] however, symptoms can include vertigo,[2] pulsatile tinnitus, conductive hearing loss or sensorineural hearing loss via bone erosion of the otic capsule in rare cases.[3] Hearing loss in children can also cause developmental delays.[4]
Cause
During pregnancy, the stapedial artery originates as a branch of the hyoid artery in the dorsal branch of the second aortic arch, which is in turn connected to the internal carotid artery. The stapedial artery after passing through the stapes splits into two vessels, the supraorbital branch and the maxillomandibular branch, the latter of which has a smaller mandibular branch. The former later anastomoses with the ophthalmic artery and becomes the middle meningeal artery, the latter anastomoses with the internal maxillary branch of the external carotid artery, becoming the inferior alveolar artery and infraorbital artery, respectively.[3]
Diagnosis
Since most cases of PSA do not present with symptoms, it is usually discovered incidentally upon middle ear surgery, or during postmortem temporal bone dissections.[5] The absence of the foramen spinosum is sometimes associated with a PSA,[6] although the prevalence of a missing foramen spinosum is much higher than the prevalence of a PSA.[7] On the other hand, a foramen spinosum may be present if the maxillomandibular artery originates from the stapedial artery.[8] A differential diagnosis can help eliminate other possible conditions such as glomus tumour of the tympanicum, facial nerve schwannoma, and aberrant internal carotid artery (ICA) based on results of high-resolution computed tomograms, angiograms, or magnetic resonance angiograms.[9] An aberrant ICA refers to when agenesis of the cervical portion of the ICA occurs, causing the inferior tympanic artery to anastomose with the caroticotympanic artery. This causes the internal carotid artery to enter the middle ear through the same canal as the tympanic nerve, rather than the normal carotid canal.[10] Aberrant internal carotid arteries are often found alongside a PSA,[1][11] although both anomalies can occur independent of each other.[10]
Treatment
Treatment of PSA usually involves some form of coagulation, either laser coagulation or electrocoagulation.[12] Palliative care such as the installation of hearing aids can help resolve hearing loss caused by a PSA;[13] conversely, the PSA may prevent the insertion of cochlear implants meant to alleviate the hearing loss.[14] Ablation of the PSA is also an option, although this treatment carries the risk of potential facial nerve damage and haemorrhage.[13]
The central hospital of the University of Porto reported in 2016 the first successful implementation of a bone-anchored hearing aid in an 8-year-old patient without complications, successfully resolving their hearing loss.[4] Further successful insertions of cochlear implants to resolve hearing loss have also been reported.[15]
Epidemiology
The prevalence of persistent stapedial arteries is thought to be somewhere between 0.02 and 0.48% of the general population;[16][N 1] a study in the American Journal of Radiology in 2000 stated that only fifty-six cases of PSA had been reported since the first report of PSA was published in 1836 by Austrian anatomist Josef Hyrtl.[1]
Notes
- ^ 0.02% by incidence during surgery, 0.48% histopathologically.[16][17]
References
- ^ a b c Silbergleit R, Quint DJ, Mehta BA, et al. (March 2000). "The Persistent Stapedial Artery". American Journal of Radiology. 21 (3): 572–577. PMC 8174972. PMID 10730654.
- ^ Sanjuan M, Chapon F, Magnan J (August 2020). "An atypical stapedial artery". The Journal of International Advanced Otology. 16 (2): 274–277. doi:10.5152/iao.2019.4002. PMC 7419084. PMID 32510458.
- ^ a b Tien HC, Linthicum FH (November 2001). "Persistent Stapedial Artery". Otology & Neurotology. 22 (6): 975–976. doi:10.1097/00129492-200111000-00044. PMID 11698828.
- ^ a b Santos M, Esteves SS, Pinto A, et al. (15 December 2016). "Clinical Experience of bone-anchored hearing aid in a patient with Persistent Stapedial Artery". Acta Otorrinolaringológica. 9 (1): 140–145. ISSN 2340-3438.
- ^ Bonasia S, Smajda S, Ciccio G, et al. (September 2020). "Stapedial Artery: From Embryology to Different Possible Adult Configurations". American Journal of Neuroradiology. 41 (10): 1768–1776. doi:10.3174/ajnr.A6738. PMC 7661070. PMID 32883664.
- ^ Guinto FC, Garrabrant EC, Radcliffe WB (November 1972). "Radiology of the Persistent Stapedial Artery". Radiology. 105 (2): 365–369. doi:10.1148/105.2.365. PMID 5079662.
- ^ Klostranec JM, Krings T (2022). "Cerebral neurovascular embryology, anatomic variations, and congenital brain arteriovenous lesions". Journal of NeuroInterventional Surgery. 14 (9): 910–919. doi:10.1136/neurintsurg-2021-018607. PMID 35169032. S2CID 246829491.
- ^ Hitier M, Zhang M, Labrousse M, et al. (2013). "Persistent stapedial arteries in human: from phylogeny to surgical consequences". Surgical and Radiologic Anatomy. 35 (10): 883–891. doi:10.1007/s00276-013-1127-z. PMID 23640742. S2CID 21065191.
- ^ Yilmaz T, Bilgen C, Savas R, Alper H (June 2003). "Persistent Stapedial Artery: MR Angiographic and CT Findings". American Journal of Neuroradiology. 24 (6): 1133–1135. PMC 8148996. PMID 12812939.
- ^ a b Hatipoglu HG, Cetin MA, Yuksel E, et al. (May 2011). "A case of a coexisting aberrant internal carotid artery and persistent stapedial artery: The role of MR angiography in the diagnosis". Ear, Nose & Throat Journal. 90 (5): 17–20. doi:10.1177/014556131109000513. PMID 21563075.
- ^ Sullivan AM, Curtin HD, Moonis G (February 2019). "Arterial Anomalies of the Middle Ear: A Pictorial Review with Clinical-Embryologic and Imaging Correlation". Neuroimaging Clinics of North America. 29 (1): 93–102. doi:10.1016/j.nic.2018.09.010. PMID 30466646. S2CID 53716332.
- ^ Quarte R, Manipoud P, Schmerber S (June 2019). "Persistent stapedial artery in PHACE syndrome". European Annals of Otorhinolaryngology, Head and Neck Diseases. 136 (3): 215–217. doi:10.1016/j.anorl.2019.02.015. PMID 30876851.
- ^ a b Hill FC, Teh B, Tykocinski M (2018). "Persistent Stapedial Artery with Ankylosis of the Stapes Footplate". Ear, Nose & Throat Journal. 97 (7): 227–228. doi:10.1177/014556131809700702. PMID 30036438.
- ^ Wardrop P, Kerr AI, Moussa SA (September 1995). "Persistent stapedial artery preventing successful cochlear implantation: a case report". The Annals of Otology, Rhinology, and Laryngology. 166: 443–445. PMID 7668745.
- ^ Jones H, Hintze J, Gendre A, et al. (2022). "Persistent Stapedial Artery Encountered during Cochlear Implantation". Case Reports in Otolaryngology. 2022: 1–3. doi:10.1155/2022/8179062. PMC 8888055. PMID 35242393.
- ^ a b Moreano EH, Paparella MM, Zelterman D, et al. (2 March 1993). "Prevalence of facial canal dehiscence and of persistent stapedial artery in the human middle ear: A report of 1000 temporal bones". The Laryngoscope. 104 (3 Pt 1): 309–320. doi:10.1288/00005537-199403000-00012. PMID 8127188. S2CID 10575546.
- ^ Jehl J, Jeunet L, Berraiah M, et al. (2006). "Bilateral Persistent Pharyngo-Stapedial Arteries Revealed during Evaluation of a Carotid-Cavernous Fistula". Interventional Neuroradiology. 12 (4): 327–334. doi:10.1177/159101990601200406. PMC 3354603. PMID 20569590.