Sasano Yoshiyuki, Yaguchi Yuichiro, Koizuka Izumi, Komori Manabu
Department of Otolaryngology, St. Marianna University School of Medicine, Kawasaki, JPN.
Cureus. 2024 Nov 9;16(11):e73337. doi: 10.7759/cureus.73337. eCollection 2024 Nov.
The persistent stapedial artery (PSA) is an exceedingly vascular anomaly that can lead to hearing loss or pulsatile tinnitus, yet its preoperative diagnosis is often challenging. We report the case of a 24-year-old woman with bilateral PSA and stapes ankylosis who presented with progressive bilateral mixed hearing loss. The patient was initially diagnosed with bilateral congenital stapes ankylosis and stapes surgery was performed on the left side using transcanal endoscopic ear surgery (TEES). Intraoperative observation of the tympanic cavity revealed the presence of a persistent stapedial artery. The stapes surgery was completed successfully while preserving the stapedial artery, resulting in postoperative hearing improvement. Subsequently, surgery was planned for the right ear. Suspecting the possibility of PSA, we performed a contrast CT scan; additionally, we prepared subtraction images and CT angiography. These images strongly suggested the presence of the PSA on the right side as well. This case highlights the superior surgical visualization provided by TEES and underscores the effectiveness of advanced imaging techniques in diagnosing PSA.
永存镫骨动脉（PSA）是一种极为罕见的血管异常，可导致听力丧失或搏动性耳鸣，但其术前诊断往往具有挑战性。我们报告一例24岁双侧PSA并镫骨固定的女性患者，其表现为进行性双侧混合性听力损失。该患者最初被诊断为双侧先天性镫骨固定，并在左侧采用经耳道内镜耳手术（TEES）进行了镫骨手术。术中观察鼓室发现存在永存镫骨动脉。在保留镫骨动脉的情况下成功完成了镫骨手术，术后听力得到改善。随后，计划对右侧耳朵进行手术。由于怀疑存在PSA，我们进行了增强CT扫描；此外，我们还准备了减影图像和CT血管造影。这些图像强烈提示右侧也存在PSA。该病例突出了TEES提供的卓越手术视野，并强调了先进成像技术在诊断PSA方面的有效性。
