The Many Faces of Persistent Stapedial Artery: CT Findings and Embryologic Explanations

Abstract

Persistent stapedial artery is a vascular anomaly with both clinical and surgical implications. Because of its scarcity, however, it remains underrecognized on imaging. Presented here is a series of 10 cases, demonstrating characteristic CT findings associated with this vascular anomaly and its most common pathognomonic imaging signs. The variable morphologic configurations and their corresponding embryologic underpinnings are described. Clinical and surgical implications of this rare anomaly are discussed.

Imaging Case of the Month: Oval Window Atresia and Aberrant Branching of the Petrous Internal Carotid

“…Oval window atresia is a congenital malformation frequently associated with aberrant course of the facial nerve and abnormalities of the incus lenticular process and stapes superstructure (1). By contrast, the course of the anomalous branch of the petrous internal carotid observed in this patient is not consistent with the typical pattern of persistent embryologic derivatives in the middle ear such as persistent stapedial artery, which is almost uniformly associated with absence of the foramen spinosum (2). To our knowledge, the pattern of oval window atresia with anomalous internal carotid artery branching has not been reported with VACTERL association or overlapping syndromes such as Fanconi anemia, Feingold syndrome, Fryns syndrome, Townes–Brocks, or oculo-auriculo-vertebral syndrome (3).…”

Middle meningeal artery arising from the petrous internal carotid artery: Outcome of unusual stapedial artery regression

“…It emerges from the petrous portion of the ICA through the caroticotympanic canaliculus. [ 14 ] The other variant, the persistent pharyngostapedial artery, is supplied by an enlarged inferior tympanic artery originating from the ascending pharyngeal artery or cervical ICA. It traverses through the inferior tympanic canaliculus into the middle ear, where it forms an anastomosis with the embryonic hyoid artery.…”

“…It traverses through the inferior tympanic canaliculus into the middle ear, where it forms an anastomosis with the embryonic hyoid artery. [ 2 , 14 ] Rodesch et al . reported a case of a hyoid stapedial artery originating from the petrous ICA, coursing within the middle ear and middle cranial fossa, giving off the middle meningeal artery, and then exiting the skull through the foramen spinosum to become the maxillary artery.…”

“…It traverses through the inferior tympanic canaliculus into the middle ear, where it forms an anastomosis with the embryonic hyoid artery. [2,14] Rodesch et al reported a case of a hyoid stapedial artery originating from the petrous ICA, coursing within the middle ear and middle cranial fossa, giving off the middle meningeal artery, and then exiting the skull through the foramen spinosum to become the maxillary artery. [18] Notably, the middle meningeal artery can arise from different segments of the ICA, indicating that the vestiges of the stapedial artery may not always traverse the tympanic cavity, as seen in our case.…”

Persistent Stapedial Artery, Oval Window Atresia and Congenital Stapes Agenesis—Case Report

“…Its passage through the crus of the stapes limits the size of the artery, which can no longer supply the necessary blood to the final structures over a certain body size. This, and the later connection of the internal and external carotid artery through the anastomosis between the maxillomandibular division of the stapedial artery and the distal ventral pharyngeal artery, promote the involution of the stapedial artery in normal humans [ 15 ].…”