Persistent Stapedial Artery and Chronic Otitis Media
Persistent Stapedial Artery and Chronic Otitis Media
复制标题
持续性镫骨动脉和慢性中耳炎
DOI：
10.1067/mhn.2000.109931
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
A. Antonelli
中科院分区：
文献类型：
--
作者：
D. Zanetti;C. Piazza;A. Antonelli
中耳炎伴听力丧失和化脓性耳鸣，伴随出生时右耳持续性搏动性耳鸣。最后一个症状以前被归因于中耳疾病。除此之外，她的病史和家族史并不显著。纯音听力图显示在低频范围内中度双侧传导性听力损失。耳镜检查显示一条大的搏动性血管穿过右侧次全鼓膜穿孔。其走行及其与邻近解剖结构的关系提示永存镫骨动脉（PSA）。因此，对颞骨进行高分辨率CT扫描，以排除中耳或内耳畸形，通常与该发现相关。1放射学检查在这方面呈阴性，并通过右侧面神经管鼓室部分靠近膝状神经节的扩大间接证实了PSA的存在。右侧棘孔的缺失表明缺乏来自上颌内部的正常脑膜中动脉分支，与PSA的诊断一致。2未检测到中耳瘤，并且没有血管造影的临床指征。显微耳镜检查允许可视化血管朝向颅内室的完整过程。病人在全身麻醉下接受自体耳屏软骨膜鼓膜成形术。在手术中发现血管直径为2 mm，从下鼓室底部穿过岬和镫骨脚之间（图1）。动脉进入面神经管的位置正好在耳蜗突后面。未发现镫骨强直或听骨畸形。避免在迷走动脉上进行任何手术操作，以最大限度地降低大量出血和神经后遗症的风险。1术后过程顺利，1年随访时，右侧新鼓室完好无损，未检测到炎症过程复发。患者报告耳鸣无主观变化。然后在对侧耳进行鼓膜成形术，未观察到解剖异常。
tis media with hearing loss and purulent otorrhea, associated with a persistent pulsatile tinnitus in the right ear that had been present from birth. The last symptom had been previously attributed to the middle ear disease. Her medical and family history were otherwise unremarkable. A pure-tone audiogram showed moderate bilateral conductive hearing loss in the lowfrequency range. Otoscopic examination showed a large pulsatile vessel through a right subtotal tympanic membrane perforation. Its course and relationships with adjacent anatomic structures were suggestive of a persistent stapedial artery (PSA). A high-resolution CT scan of the temporal bones was therefore performed to rule out middle or inner ear malformations, often associated with this finding.1 Radiologic examination was negative in this respect and indirectly confirmed the presence of a PSA by enlargement of the tympanic portion of the right facial canal close to the geniculate ganglion. Absence of the foramen spinosum on the right indicated a lack of normal middle meningeal artery branching from the internal maxillary, consistent with a diagnosis of PSA.2 No cholesteatoma was detected, and there was no clinical indication for an angiography. Micro-otoscopy allowed visualization of the complete course of the vessel toward the intracranial compartment. An underlay myringoplasty with autologous tragal perichondrium was performed with the patient under general anesthesia. During surgery the vessel was found to be 2 mm in diameter, coursing from the floor of the hypotympanum across the promontory and between the stapedial crura (Fig 1). The artery entered the facial canal just behind the cochleariform process. No stapedial ankylosis or ossicular malformations were seen. Any surgical maneuver on the aberrant artery was avoided to minimize the risks of profuse bleeding and neurologic sequelae.1 The postoperative course was uneventful, and at 1-year follow-up the right neotympanum was intact and no recurrence of the inflammatory process was detected. The patient reported no subjective change of the tinnitus. A myringoplasty was then performed in the opposite ear, where no anatomic abnormalities were observed.