Management of Aberrant Internal Carotid Artery Injury: A Real Emergency

Carotid artery pseudoaneurysm or fistula formation can occur due to spontaneous dissection, blunt or penetrating trauma, or iatrogenic injury. Most of the iatrogenic injuries in the petrous region occur during middle ear operations in patients with an aberrant internal carotid artery (ICA). Aberrant ICA is a rare anomaly that can be associated with life-threatening aural hemorrhage if inadvertently injured during middle ear surgery. Other causes of unexpected hemorrhage during or after middle ear surgery include high jugular bulb, aneurysm, and glomus tumor. The management of aberrant ICA injury has always been a challenging task because of the difficult surgical approach. With major advances in the neuroendovascular field, endovascular treatment of these lesions can be quick and effective. We discuss here a case of endovascular management of an aberrant ICA that was probably injured during previous middle ear operations that led to pseudoaneurysm formation and ruptured subsequent to ear infection and drainage.

Download Full-text

An aberrant internal carotid artery in the temporal bone presenting as a middle-ear mass: a case report

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000199 ◽

2007 ◽

Vol 122 (9) ◽

pp. 983-985 ◽

Cited By ~ 10

Author(s):

A Eryilmaz ◽

M Dagli ◽

M Cayonu ◽

E Dursun ◽

C Gocer

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Temporal Bone ◽

Middle Ear ◽

Internal Carotid ◽

Middle Ear Surgery ◽

Computed Tomography Scan ◽

Ear Surgery ◽

Aberrant Internal Carotid Artery ◽

Tomography Scan

AbstractObjective:To draw attention to the possibility of an aberrant internal carotid artery behind an intact tympanic membrane presenting as a middle-ear mass.Case:A 48-year-old female patient presented with a hearing impairment in her right ear that had started 10 years ago. Otoscopic examination revealed a retro-tympanic mass. A high resolution computed tomography scan of the temporal bone was performed that showed protrusion of the internal carotid artery into the middle ear. Magnetic resonance angiography provided excellent visualisation of the internal carotid artery. Finally, a diagnosis of an aberrant internal carotid artery was made and the patient was evaluated with a conservative approach.Conclusion:All retro-tympanic masses should ideally be visualised with a computed tomography scan of the temporal bone before any middle-ear surgery, such as tympanotomy and biopsy, and it is essential for every otologist who undertakes myringotomy and middle-ear surgery to know about this rare entity.

Download Full-text

Aberrant internal carotid artery in the middle ear: the duplication variant

BMJ Case Reports ◽

10.1136/bcr-2018-228865 ◽

2019 ◽

Vol 12 (4) ◽

pp. e228865

Author(s):

Andreas Anagiotos ◽

Maria Kazantzi ◽

Marios Tapis

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Middle Ear Surgery ◽

Base Level ◽

Pulsatile Mass ◽

Aberrant Internal Carotid Artery ◽

History Of

Vascular variants concerning the internal carotid artery (ICA) at the skull base level are rare. Correct workup and diagnosis in case of suspicion of such a variant are important as it mimics glomus tumours and could complicate myringotomy or middle ear surgery. We report a case of a 39-year-old woman presented with a 6-month history of right pulsatile tinnitus and aural fullness. Ear microscopy examination revealed a pale red pulsatile mass anterior to the umbo. Radiological assessment using CT and MRI/magnetic resonance angiography confirmed the diagnosis of an aberrant ICA. Interestingly, a duplication of the ICA was demonstrated, in which the enlarged inferior tympanic artery presented as the aberrant ICA, whereas a narrower collateral hypoplastic native ICA was also present. A conservative approach with regular follow-up appointments was recommended.

Download Full-text

The internal carotid artery in relation to middle ear surgery

Clinical Otolaryngology ◽

10.1111/j.1365-2273.1982.tb01401.x ◽

1982 ◽

Vol 7 (6) ◽

pp. 381-388 ◽

Cited By ~ 3

Author(s):

D. HOWARD

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Middle Ear Surgery ◽

Ear Surgery

Download Full-text

Aberrant internal carotid artery lying within the middle ear

Neuroradiology ◽

10.1007/bf00339565 ◽

1985 ◽

Vol 27 (4) ◽

pp. 322-326 ◽

Cited By ~ 18

Author(s):

J. D. Swartz ◽

Margaret L. Bazarnic ◽

T. P. Naidich ◽

L. D. Lowry ◽

H. T. Doan

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Aberrant Internal Carotid Artery

Download Full-text

Aberrant Internal Carotid Artery in the Middle Ear

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948109000117 ◽

1981 ◽

Vol 90 (1) ◽

pp. 67-69 ◽

Cited By ~ 24

Author(s):

Roy S. Goodman ◽

Noel L. Cohen

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Stapedial Artery ◽

Rare Anomaly ◽

Bony Canal ◽

Aberrant Internal Carotid Artery ◽

Ear Symptoms

Aberrant internal carotid artery in the middle ear is a rare anomaly. Myringotomy in a patient with this anomaly caused violent hemorrhage, requiring immediate packing and eventual ligation of the artery. The anomaly may represent the artery bulging through a dehiscent bony canal, or it may be due to traction on the developing carotid by a persistent stapedial artery. Various middle ear symptoms have been reported in earlier cases. Diagnosis is by angiography, and therapy is surgical.

Download Full-text

Otorrhagia from the “Aberrant Internal Carotid” Artery in the Middle Ear

Interventional Neuroradiology ◽

10.1177/159101999700300305 ◽

1997 ◽

Vol 3 (3) ◽

pp. 231-238 ◽

Cited By ~ 3

Author(s):

M. Söderman ◽

M. Moersdorf ◽

M. Lysdahl ◽

L. Mendel

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Large Artery ◽

Arterial Aneurysm ◽

Anatomical Variant ◽

Cervical Portion ◽

Aberrant Internal Carotid Artery ◽

The Brain

Agenesis of the cervical portion of the internal carotid artery (ICA) may result in blood supply to the ipsilateral cerebral hemisphere being provided by an enlarged inferior tympanic branch of the ascending pharyngeal artery. This enlarged vessel, passing through Jacobson's canal and anastomosing with the likewise enlarged caroticotympanic branch of the ICA in front of the promontorium, may simulate a middle ear mass. We present five patients with this unusual anatomical variant, three of which underwent biopsy of what was believed to be a middle ear tumour. One patient experienced rupture of an arterial aneurysm in the middle ear successfully treated with endovascular application of detachable platinum coils. It is mandatory for ENT-surgeons and radiologists who perform head-and-neck examinations to recognize this anatomical variant, not mistaking it for a tumour, since biopsy of a large artery supplying the brain may have disastrous consequences. In patients with otorrhagia, an arterial aneurysm must be considered as a possible source of bleeding, in some cases amenable for treatment with an endovascular technique. The diagnosis of “aberrant internal carotid artery” is usually made with CT of the temporal bone or MR of the skull base. Cerebral angiography is in most cases not necessary, unless an endovascular procedure is planned.

Download Full-text

Aberrant Internal Carotid Artery in the Middle Ear

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940111000915 ◽

2001 ◽

Vol 110 (9) ◽

pp. 892-894 ◽

Cited By ~ 9

Author(s):

Gerd Jürgen Ridder ◽

Milo Fradis ◽

Jörg Schipper

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Aberrant Internal Carotid Artery

Download Full-text

Summary Aberrant Internal Carotid Artery in the Middle Ear

JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY ◽

10.5106/jjshns.14.315 ◽

2004 ◽

Vol 14 (3) ◽

pp. 315-318

Author(s):

Yasuo Mishiro ◽

Tadashi Kitahara ◽

Yoshifumi Yamamoto ◽

Takeshi Kubo

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Aberrant Internal Carotid Artery

Download Full-text

Aberrant internal carotid artery presenting as a retrotympanic vascular mass

Acta Radiologica Short Reports ◽

10.1177/2047981614553695 ◽

2014 ◽

Vol 3 (10) ◽

pp. 204798161455369 ◽

Cited By ~ 1

Author(s):

Simon Nicolay ◽

Bert De Foer ◽

Anja Bernaerts ◽

Joost Van Dinther ◽

Paul M Parizel

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Young Woman ◽

Middle Ear ◽

Internal Carotid ◽

Preoperative Planning ◽

Aberrant Internal Carotid Artery ◽

Cervical Segment ◽

Collateral Pathway ◽

Vascular Variant

We report a case of a young woman with an aberrant right internal carotid artery (ICA) presenting as a retrotympanic reddish mass. This variant of the ICA represents the collateral pathway that is formed as a result of an embryological agenesis of the cervical segment of the ICA. The embryonic inferior tympanic artery is recruited to bypass the absent carotid segment. This hypertrophied vessel may be seen otoscopically and wrongfully considered to be a vascular middle ear tumor. Informing the otorhinolaryngologist of this important vascular variant not only obviates biopsy but also helps in careful preoperative planning of eventual middle ear procedures.

Download Full-text