Aberrant internal carotid artery in the middle ear: a case report

Abstract

Aberrant course of the internal carotid artery within the middle ear is a rare condition. Surgical interventions following clinical or radiological misinterpretations may lead to fatal complications. A 23-year-old female patient presented with a hearing impairment of 10- month duration. On otoscopic examination, the left tympanic membrane was intact, but there was a pul- satile lesion in the tympanic cavity, synchronous with the heartbeats. Pure-tone audiometric examination of the left ear showed a unilateral mixed hearing loss, especially in low frequencies. Computed tomography showed protrusion of the internal carotid artery into the middle ear from the lateral and superior aspects of the cochlea. Magnetic resonance imaging and MR- angiography showed a left-sided deviation of the left internal carotid artery near the cochlea, associated with a filling defect. The caliber of the left internal carotid artery was narrower than the right one in the middle ear, and its proximal part was thinner. A diag- nosis of aberrant internal carotid artery was made.

Keywords

• Carotid artery, internal/abnormalities, ear, middle/abnormalities

Orta kulakta aberan internal karotid arter: Olgu sunumu

Abstract

Orta kulakta aberan karotid arter nadir bir anomali- dir. Tanıda klinik ve radyolojik yanılma sonucu ya- pılan cerrahi girişimler bu hastalarda ölümcül ola- bilmektedir. On aydır sol kulakta işitme azlığı yakın- masıyla başvuran 23 yaşındaki kadın hastanın otoskopik bakısında sol kulakta timpan zar intakttı ve anteroinferior kadranda nabızla senkronize pul- sasyon izlendi. Tonal odyometride sol kulakta, özel- likle pes frekanslarda daha belirgin olmak üzere mikst tip işitme kaybı vardı. Bilgisayarlı tomografide internal karotid arterin kokleanın lateralinde ve su- periorunda orta kulağa uzanım gösterdiği belirlen- di. Manyetik rezonans görüntüleme MRG ve MR- anjiyo incelemelerinde sol internal karotid arterin kokleaya yakın bölgede, sola doğru kıvrım göster- diği ve bu bölgede dolum defekti olduğu görüldü. Orta kulakta sol internal karotid arter kalibresi sağa oranla daha küçüktü ve solda arterin proksimali normalden daha inceydi. Hastaya aberan karotid arter tanısı kondu

Keywords

• Karotid arter, internal/anormallik, kulak, orta/anormallik

References

1. Oates JW, McAuliffe W, Coates HL. Management of pseudo-aneurysm of a lateral aberrant internal carotid artery. Int J Pediatr Otorhinolaryngol 1997;42:73-9.
2. Koizuka I, Hattori K, Tsutsumi K, Sakuma A, Katsumi N, Kikuchi H, et al. Objective tinnitus caused by an aberrant internal carotid artery. Auris Nasus Larynx 1998;25:323-7.
3. Swartz JD, Harnsberger HR. Temporal bone-vascular anatomy, anomalies and diseases. In: Harnsberger HR, editor. Imaging of the temporal bone. 3rd ed. New York: Thieme: 1998. p. 188-95.
4. Janfaza P, Nadol JB Jr, Galla R, Fabian RL, Montgomery WW, editors. Surgical anatomy of the head and neck. Philadelphia: Lippincott Williams & Wilkins; 2000. Çeviri editörü: Cansız H. Temporal kemik ve kulak. In: Baş ve boyunun cerrahi anatomisi. 1. Baskı. İstanbul: Nobel Tıp Kitapevi; 2002. s. 463.
5. Moreano EH, Paparella MM, Zelterman D, Goycoolea MV. Prevalence of carotid canal dehiscence in the human middle ear: a report of 1000 temporal bones. Laryngoscope 1994;104(5 Pt 1):612-8.
6. Glasscock ME 3rd, Seshul M, Seshul MB Sr. Bilateral aberrant internal carotid artery case presentation. Arch Otolaryngol Head Neck Surg 1993;119:335-9.
7. Mancuso AA, Hanafee WN. Temporal bone-normal anatomy, pathology, technique and indication for scan- ning. In: Mancuso AA, Hanafee WN, editors. Computed tomography and magnetic resonance imaging of the head and neck. 2nd ed. Baltimore: Williams and Wilkins; 1982. p. 88-138.
8. Sinnreich AI, Parisier SC, Cohen NL, Berreby M. Arterial malformations of the middle ear. Otolaryngol Head Neck Surg 1984;92:194-206.

9. Henriksen SD, Kindt MW, Pedersen CB, Nepper- Rasmussen HJ. Pseudoaneurysm of a lateral internal carotid artery in the middle ear. Int J Pediatr Otorhinolaryngol 2000;52:163-7.
10. Lasjaunias P, Moret J, Manelfe C, Theron J, Hasso T, Seeger J. Arterial anomalies at the base of the skull. Neuroradiology 1977;13:267-72.
11. Campbell G, Renner G, Estrem SA. Bilateral aberrant internal carotid arteries. Otolaryngol Head Neck Surg 1992;107:124-8.
12. Ibarra RA, Kesava P, Fewins JL. Congenital otosclero- sis in a child with bilateral aberrant internal carotid arteries. AJR Am J Roentgenol 2001;176:263-4.
13. Chang CY. Aberrant carotid artery of the middle ear. Otolaryngol Head Neck Surg 2000;122:154.
14. Leveque H, Bialostozky F, Blanchard CL, Suter CM. Tympanometry in the evaluation of vascular lesions of the middle ear and tinnitus of vascular origin. Laryngoscope 1979;89:1197-218.
15. Botma M, Kell RA, Bhattacharya J, Crowther JA. Aberrant internal carotid artery in the middle-ear space. J Laryngol Otol 2000;114:784-7.
16. Lapayowker MS, Liebman EP, Ronis ML, Safer JN. Presentation of the internal carotid artery as a tumor of the middle ear. Radiology 1971;98:293-7.
17. Ruggles RL, Reed RC. Treatment of aberrant carotid arteries in the middle ear: a report of two cases. Laryngoscope 1972;82:1199-205.
18. Hunt JT, Andrews TM. Management of aberrant inter- nal carotid artery injuries in children. Am J Otolaryngol 2000;21:50-4.