Successful Cochlear Implantation in the Face of Persistent Stapedial Artery: Surgical Technique and Imaging Features

Lindemann, Timothy L.; Austin, K. L.; Clinic, Kentucky KY Hearing

doi:10.5152/iao.2020.8964

Cited by 4 publications

(3 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the literature, the average diameter of the FN tympanic segment and the mastoid segment is reported to be 1.093 mm (±0.573) and 1.332 mm (±0.649), respectively. 5 The possible diagnosis of persistent stapedial artery (PSA) was raised but was found to be unlikely due to (a) the presence of a normal ipsilateral foramen spinosum which may be absent or hypoplastic in PSA ( Figure 3 ), (b) the larger than normal diameter of the mastoid segment of the fallopian canal (2.1 mm) which is not typical of PSA, and (c) the absence of a blood vessel and canal originating from the internal carotid artery which may be present in PSA as described by Lindemann et al 6 This case emphasizes the importance of assessing the diameter of the facial nerve. When a deviation from the norm is noted, the possibility of obtaining additional imaging such as CT venography or MRI before surgery should be considered.…”

Section: Discussionmentioning

confidence: 93%

Vascular Anomaly in the Fallopian Canal Encountered Unexpectedly During Cochlear Implantation

Chen¹,

Sichel²,

Ben-David³

et al. 2021

Int Adv Otol

View full text Add to dashboard Cite

A 68-year-old male with progressive sensorineural hearing loss underwent left cochlear implant surgery. While developing the posterior tympanotomy and identifying the facial nerve mastoid segment, gentle stimulation by the nerve stimulator resulted in unexpected profuse venous bleeding. After achieving hemostasis with Surgicel and Spongostan, the posterior tympanotomy was extended exposing a large aberrant vein running parallel to the tympanic and mastoid segments of the facial nerve in the fallopian canal. Good exposure and careful palpation of the vein assisted in ruling out facial nerve hemangioma. An intraoperative decision to proceed with implantation, taking into account limited benefit from future magnetic resonance imaging, was taken. The patient had a temporary 3-month post-operative facial nerve weakness, probably from pressure applied during hemostasis. Auditory cochlear implant function was excellent. A larger than normal diameter of the tympanic and mastoid segments of the facial nerve was seen in re-reviews of the preoperative computed tomography. We believe drawing the readers' attention to this anomaly, which to the best of our knowledge has not been previously described, can assist in the choice of preoperative imaging and increase awareness of deviation from the norm of facial nerve diameter. In addition, knowledge of possible venous anomalies may aid surgeons in such intraoperative decisions.

show abstract

Section: Discussionmentioning

confidence: 93%

Vascular Anomaly in the Fallopian Canal Encountered Unexpectedly During Cochlear Implantation

Chen¹,

Sichel²,

Ben-David³

et al. 2021

Int Adv Otol

View full text Add to dashboard Cite

show abstract

“…To our knowledge, this is only the second report published of a successful cochlear implant in a patient with a PSA [ 8 ]. In this case, successful implantation was achieved by the usual postauricular approach, cortical mastoidectomy, and posterior tympanotomy.…”

Section: Discussionmentioning

confidence: 99%

Persistent Stapedial Artery Encountered during Cochlear Implantation

Jones

Hintze

Gendre

et al. 2022

Case Reports in Otolaryngology

View full text Add to dashboard Cite

Objectives. Persistent stapedial artery (PSA) is a rare congenital anomaly that can complicate middle ear surgery. Methods. We present the case of a 25-year-old male who underwent right-sided cochlear implantation. A PSA was encountered lying over the middle promontory intraoperatively. Results. The PSA was carefully lifted off the middle ear promontory using a Hughes elevator to divide adhesions and delineate the artery. The implant electrode was placed through the round window niche in the usual fashion. Tragal cartilage and fibrin glue were used to control the trajectory of the electrode. Conclusion. Cochlear implantation can be performed safely in patients with PSA.

show abstract

“…This topic is the subject of a separate case report from the senior author (AKG). 13 Metallic structures such as wires can cause scatter on conventional HRCT scans. This makes accurate measurements of small, metallic foreign objects difficult.…”

Section: Discussionmentioning

confidence: 99%

Gray-Scale Inversion on High Resolution Computed Tomography of the Temporal Bone: An Observational Study

Schwartz

Lindemann

Mongelluzzo

et al. 2021

Ann Otol Rhinol Laryngol

Self Cite

View full text Add to dashboard Cite

Objectives: This is a qualitative study to explore the utility of gray-scale inversion or the “invert” function of high-resolution computed tomography (HRCT) scans in the diagnosis of temporal bone anatomy and pathology. Methods: This is a case series describing an innovative application of an existing image processing tool to visualize temporal bone anatomy and pathology. Illustrative patients at a tertiary referral center with otologic symptoms and findings leading to HRCT scans of the temporal bone were included. Diagnostic HRCT scans were evaluated utilizing the gray-scale inversion function (invert function). Results: Nine illustrative cases which demonstrate conditions such as persistent stapedial artery, membranous stapes footplate, total ossicular prosthesis migration into the vestibule, third window syndrome such as superior semicircular canal dehiscence (SSCD) and cochlea-facial nerve dehiscence, otosclerosis, and ossicular chain discontinuity are included. The enhanced visualization was confirmed surgically in 3 cases, and 1 had physiological confirmation using cervical vestibular evoked myogenic potentials (cVEMP). Conclusions: Gray-scale inversion can be used to improve visualization of temporal bone anatomy and pathologic changes when diagnoses are in doubt. The invert function is a useful adjunct in the armamentarium of both radiologists and otologists when evaluating HRCT of the temporal bone.

show abstract

Successful Cochlear Implantation in the Face of Persistent Stapedial Artery: Surgical Technique and Imaging Features

Cited by 4 publications

References 7 publications

Vascular Anomaly in the Fallopian Canal Encountered Unexpectedly During Cochlear Implantation

Vascular Anomaly in the Fallopian Canal Encountered Unexpectedly During Cochlear Implantation

Persistent Stapedial Artery Encountered during Cochlear Implantation

Gray-Scale Inversion on High Resolution Computed Tomography of the Temporal Bone: An Observational Study

Contact Info

Product

Resources

About