1
|
O'Bryan CJ, Klemens JJ. Incidental Finding of a Persistent Stapedial Artery in a Patient Presenting With Conductive Hearing Loss. EAR, NOSE & THROAT JOURNAL 2023; 102:NP552-NP555. [PMID: 34233519 DOI: 10.1177/01455613211032005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A persistent stapedial artery is a congenital vascular malformation that can cause tinnitus and/or conductive hearing loss. Although rare, this case highlights the importance of recognizing aberrant anatomy as a potential cause of patients' symptoms. It also demonstrates how to recognize and treat patients with a symptomatic persistent stapedial artery.
Collapse
|
2
|
Sugano GT, Pauris CC, Silva YBE, Pandini FE, Palermo RBS, Buchaim DV, Buchaim RL, Chacon EL, Aparecida de Castro C, Pagani BT, da Cunha MR. Topographic and Morphometric Study of the Foramen Spinosum of the Skull and Its Clinical Correlation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121740. [PMID: 36556942 PMCID: PMC9785582 DOI: 10.3390/medicina58121740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives: The spinous foramen (FS) of the skull is an opening located in the greater wing of the sphenoid bone at the base of the skull, and it includes the middle meningeal vessels and the meningeal branch of the mandibular trigeminal nerve. The FS is commonly used as an anatomical landmark in neurosurgical procedures and neuroimaging of the middle cranial fossa because of its relationship with other cranial foramina and surrounding vascular and nervous structures. Thus, specific knowledge of its topography and possible anatomical variations is important regarding some surgical interventions and skull imaging. The aim of this study was to provide further details on the morphology of the FS of the skull by evaluating its topographic and morphometric relationships and correlating the findings with clinical practice. Materials and Methods: Thirty dried skulls of human skeletons from body donors from the collection of the Laboratory of Anatomical Microdissection at a medical school were used. The metric dimensions and variations of the FS and its relationship with adjacent bone structures were analyzed with an interface digital microscope. Results: The results showed the bilateral presence of the FS in all skulls; however, differences were observed in the shape, diameter, and topography in relation to the foramen ovale and the spine of the sphenoid. The FS was present in the greater wing of the sphenoid bone; however, in one skull, it was located in the lateral lamina of the pterygoid process. The FS was smaller than the foramen ovale. A round and oval FS shape was the most common (42.1% and 32.8% of the samples, respectively), followed by drop-shaped (12.5%) and irregular-shaped (12.5%) foramina. Conclusions: In conclusion, FS variations among individuals are common and must be considered by surgeons during skull base interventions in order to avoid accidents and postoperative complications.
Collapse
Affiliation(s)
- Gustavo Tenório Sugano
- Department of Morphology and Pathology, Jundiaí Medical School, Jundiaí 13202-550, Brazil
| | - Carolina Chen Pauris
- Department of Morphology and Pathology, Jundiaí Medical School, Jundiaí 13202-550, Brazil
- Anatomy Department, Padre Anchieta University Center (UniAnchieta), Jundiaí 13210-795, Brazil
| | - Yggor Biloria e Silva
- Department of Morphology and Pathology, Jundiaí Medical School, Jundiaí 13202-550, Brazil
- Anatomy Department, Padre Anchieta University Center (UniAnchieta), Jundiaí 13210-795, Brazil
| | - Fabrício Egídio Pandini
- Department of Surgery (Otorhinolaryngology), Jundiaí Medical School, Jundiaí 13202-550, Brazil
| | | | - Daniela Vieira Buchaim
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, Brazil
- Teaching and Research Coordination of the Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
| | - Rogerio Leone Buchaim
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of Sao Paulo, Bauru 17012-901, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo, Sao Paulo 05508-270, Brazil
- Correspondence: ; Tel.: +55-14-3235-8220
| | - Erivelto Luís Chacon
- Department of Morphology and Pathology, Jundiaí Medical School, Jundiaí 13202-550, Brazil
| | - Cynthia Aparecida de Castro
- Laboratory of Inflammation and Infectious Diseases, Department of Morphology and Pathology, Federal University of Sao Carlos, Sao Carlos 13565-905, Brazil
| | | | - Marcelo Rodrigues da Cunha
- Department of Morphology and Pathology, Jundiaí Medical School, Jundiaí 13202-550, Brazil
- Anatomy Department, Padre Anchieta University Center (UniAnchieta), Jundiaí 13210-795, Brazil
| |
Collapse
|
3
|
Lindemann TL, Austin KL, Gadre AK. Successful Cochlear Implantation in the Face of Persistent Stapedial Artery: Surgical Technique and Imaging Features. J Int Adv Otol 2021; 16:463-466. [PMID: 33136029 DOI: 10.5152/iao.2020.8964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The stapedial artery is an embryologic structure that very rarely persists into adulthood. Termed the persistent stapedial artery (PSA), it is most often asymptomatic, identified retrospectively, and can complicate middle ear surgery. A 70-year-old woman presented with profound bilateral sensorineural hearing loss and elected to undergo cochlear implantation. During surgery, a pulsatile, cord-like structure was found obscuring the round window niche. A high-resolution computed tomography (HRCT) imaging review confirmed PSA diagnosis. A cochleostomy was made using a cochleostomy burr and gentle vessel compression. Complete insertion of the cochlear implant was achieved and its placement confirmed. The patient went on to develop open-set discrimination. We report the first successful case of cochlear implantation in the face of a PSA. Inverted HRCT imaging was found to enhance PSA visualization and may aid preoperative diagnosis. A cochleostomy technique is recommended for electrode insertion to minimize the risk of bleeding.
Collapse
Affiliation(s)
- T Logan Lindemann
- Lewis Katz School of Medicine at Temple University, Philadelphia, USA
| | | | - Arun K Gadre
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Pennsylvania, USA
| |
Collapse
|
4
|
Sioshansi PC, Schettino AE, Babu SC, Bojrab DI, Michaelides EM, Luryi AL, Schutt CA. Stapes surgery with a persistent stapedial artery. Am J Otolaryngol 2020; 41:102684. [PMID: 32877800 DOI: 10.1016/j.amjoto.2020.102684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To review surgical outcomes of stapes surgery for otosclerosis with persistence of the stapedial artery. MATERIALS AND METHODS A retrospective case review of a tertiary neurotology referral center of patient with otosclerosis undergoing primary stapes surgery between 2010 and 2017 found to have a persistent stapedial artery. Stapedectomy was performed with or without cauterization of the stapedial artery. The primary outcome measures include pre- and postoperative hearing as well complications. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Neurologic complications, including facial nerve function, were assessed. RESULTS Four patients out of 853 with otosclerosis undergoing stapedectomy were found to have a persistence of the stapedial artery. Mean AC PTA was 55 dB preoperatively, and 24 dB postoperatively (p = .0041), while the ABG improved on average from 31 dB to 6 dB (p = .0014). Mean follow-up time was 32 months, and there were no significant complications. Facial nerve function was preserved in all patients (House-Brackmann grade I/VI). CONCLUSIONS In the case of a persistent stapedial artery, excellent hearing outcomes are achievable for otosclerosis via stapedectomy without an apparent increased risk of neurologic complication.
Collapse
|
5
|
Lau K, Stavrakas M, Yardley M, Ray J. Lasers in Cholesteatoma Surgery: A Systematic Review. EAR, NOSE & THROAT JOURNAL 2020; 100:94S-99S. [PMID: 32809846 DOI: 10.1177/0145561320948772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The mainstay of cholesteatoma treatment is surgical and requires the removal of all squamous epithelium from the underlying normal structure. The application of laser technology in middle ear and mastoid surgery has shown promise in achieving both disease eradication and hearing preservation. This systematic review aims to include studies that have assessed the application of laser to the treatment of cholesteatoma and to review its outcomes in terms of disease eradication as well as hearing results. METHOD Two independent researchers conducted a systematic review of the literature on MEDLINE and Cochrane library, according to PRISMA guidance. RESULT The search resulted in 12 papers, reporting on 536 participants that fulfilled the inclusion criteria. The hearing results did not show that using laser surgery improved hearing in cholesteatoma surgery, but neither has the use of laser shown to deteriorate hearing. With regards to the prevention of residual/recurrent cholesteatoma, the current literature reports a residual/recurrent rate of 0% to 33%. The complication rate of facial palsy is 0.6%. CONCLUSION While there is certainly a role for future studies especially randomised large-cohort prospective comparative studies, the current literature suggests that laser may have a role in prevention or minimizing of residual cholesteatoma and generally have a safe hearing outcome profile.
Collapse
Affiliation(s)
- Kimberley Lau
- Otolaryngology Department, 7318Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Marios Stavrakas
- Otolaryngology Department, 7318Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Mark Yardley
- Otolaryngology Department, 7318Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Jaydip Ray
- Otolaryngology Department, 7318Sheffield Teaching Hospitals, Sheffield, United Kingdom
| |
Collapse
|