Persistent Stapedial Artery Supplying a Glomus Tympanicum Tumor

Abstract

Vascular anomalies of the middle ear are extremely rare. The most common anomaly is a persistent stapedial artery. This artery is important clinically because of the risk of profuse bleeding during middle ear surgery. We describe a 26-year-old woman with a glomus tympanicum tumor. The blood supply to the tumor was from a persistent stapedial artery. A preoperative angiogram supported this finding by demonstrating a small vessel originating from the anterior branch of the middle meningeal artery as the major vascular supply to the tumor. To our knowledge, this is the first case report of a glomus tympanicum tumor vascularized by a persistent stapedial artery that was suggested by angiography and confirmed intraoperatively. To better understand this anomaly, we review the embryological development of the stapedial artery and discuss its clinical significance.

Persistent Stapedial Artery

“…Imaging findings have been reported in several cases. Angiographic findings have been reported in seven cases (3,9,10,(12)(13)(14)(15), and CT findings have been reported in four cases (9,11,13,16). Moreano et al (17) reported a prevalence of 0.48% in a series of 1048 temporal bone dissections.…”

Persistent Stapedial Artery and Chronic Otitis Media

“…High‐resolution CT scan and angiography are useful tools to evaluate the role of this vessel and its possible relationships with intracranial vascularization. One case has been reported of a PSA supplying a glomus tympanicum tumor 4 . Rare angiographic findings described in association to this abnormality always involve the internal carotid artery, which can be absent, 4 bulging into the middle ear, 2 dilated by an intratympanic aneurysm, and fenestrated or duplicated 5 .…”

“…One case has been reported of a PSA supplying a glomus tympanicum tumor 4 . Rare angiographic findings described in association to this abnormality always involve the internal carotid artery, which can be absent, 4 bulging into the middle ear, 2 dilated by an intratympanic aneurysm, and fenestrated or duplicated 5 . Moreover, associated congenital middle or inner ear malformations frequently occur with a PSA and can be radiologically detected and a proper single‐step procedure planned.…”

Persistent Fetal Intracranial Arteries

“…A persistent stapedial artery can be associated with an aberrant internal carotid artery or other middle ear anomalies, especially of the stapes and facial nerve. Rarely, it has been detected in patients with trisomy 13, second branchial arch anomalies, Paget disease, otosclerosis, or thalidomide deformities (Boscia et al 1990). Differential diagnosis of the persistent stapedial artery includes a glomus tympanicum tumor, an aberrant carotid artery, or a high rising jugular bulb if there is a vascular mass in the middle ear or a facial nerve schwannoma if there is facial nerve enlargement (Silbergleit et al 2000).…”