0:01

This was a patient who had pulsatile tinnitus, and

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what was seen was a retrompanic vascular mass.

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On the MRA,

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it was noticed that there was a little vessel which

0:15

was arising from the cervical internal carotid

0:19

artery and was coursing along the posterior margin

0:25

of the internal carotid artery and then

0:28

went into the middle ear cavity.

0:32

Here you can see this vessel coming into the middle

0:35

ear cavity and then progressing further anteriorly.

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So this was suspected of being

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a persistent stapedial artery.

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Let me see how it looks in the

0:47

coronal plane for you.

0:48

And you can see this vessel which is coursing up and

0:53

over the cochlear promontory and presenting

0:56

as a retrotympanic vascular mass.

0:58

You don't see that on the contralateral side,

1:01

but arising from the internal carotid artery

1:06

and then coursing parallel to it and then up into

1:11

the tympanic cavity. So this is an example,

1:15

an MRA of a persistent stapedial artery presenting

1:19

as a retrotympanic vascular mass,

1:21

accounting for pulsatile tinnitus.

1:24

The patient had arteriogram for another

1:27

reason, and during the arteriogram,

1:31

the patient had a 3D imaging

1:35

of the temporal bone.

1:38

Let me just point out the right internal

1:41

artery injection here.

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This is our right internal carotid artery injection.

1:47

We are seeing

1:51

a vascular structure coming up here

1:54

towards the temporal bone.

1:56

Let me see on the here, not so well seen,

2:01

but coursing along here and then

2:03

into the temporal bone.

2:05

Let me see whether there was a rotational CT that

2:07

was performed at the same time

2:09

during the arteriogram.

2:11

And we're going to follow that vascular structure,

2:16

which is here.

2:17

You see it coming off of the internal carotid artery

2:20

and then coursing into the middle ear cavity

2:26

overlying the cochlear promontory. And then,

2:29

as we said, going towards the core of the stapes.

2:32

So here's the core of the stapes, and you see this

2:34

little vascular structure right along

2:36

the anterior crus of the stapes.

2:39

And this is an example on the rotational CTA during

2:46

the arteriogram of a persistent stapedial artery.

2:50

And it is in the differential diagnosis

2:53

of a retrotympanic vascular mass.

2:55

And another one that you want to make sure you

2:57

can distinguish from a glomus tympanic

3:00

tumor again. How do we distinguish it?

3:03

We follow it backwards and we see it connecting

3:06

up to the internal carotid artery.

3:10

Again, one of the findings that may help you with this is

3:15

the absence of the foramen spinosum posterior

3:18

lateral to the foramen ovale at the skull base.