Arterial malformations of the middle ear are rare entities which, if unrecognized, can lead to serious complications. We will present six such cases and summarize the relevant literature. Our presentation will review the development of middle ear arterial structures. Radiologic techniques useful in delineating these conditions will be described, and methods of treatment will be discussed.

Arterial malformations of the middle ear.

Seven patients with symptomatic aneurysms involving the petrous segment of the internal carotid artery were treated by endovascular techniques (six patients) or surgical ligation (one patient). Patients' ages at the time of treatment ranged from 7 to 62 years (mean, 30 years). The presenting symptoms were pain (seven patients), eighth nerve dysfunction (three patients), seventh nerve dysfunction (one patient), fifth nerve dysfunction (two patients), and bruit (one patient). Two patients, ages 7 and 19, respectively, presented with giant, partially thrombosed petrous aneurysms and had hemiatrophy of the body ipsilateral to the side of the aneurysm. Only one patient had a history of trauma; aneurysms in the remaining patients were presumed to be congenital in origin. In one patient with a saccular aneurysm, a balloon could be navigated into the aneurysm, obliterating it but preserving the parent artery. The remaining six patients had fusiform aneurysms with intraluminal thrombus and underwent proximal occlusion (four patients) or trapping procedure (two patients). In all patients, symptoms were alleviated after thrombosis of the aneurysm. The only complication was a transient visual loss in a hypercoagulable patient, occurring after carotid occlusion. Petrous carotid aneurysms can produce a wide clinical spectrum of signs and symptoms in younger patients; these aneurysms frequently are fusiform and contain chronic thrombus. They can be treated effectively by endovascular or surgical occlusive procedures.

http://www.ajnr.org/content/ajnr/11/2/253.full.pdf

Aneurysms of the petrous portion of the internal carotid artery: results of treatment with endovascular or surgical occlusion.

• A unique case of bilateral intrapetrous internal carotid aneurysms is reported. The importance of an accurate diagnosis before surgical intervention is stressed and the literature is reviewed. (Arch Otolaryngol106:172-175, 1980)

Bilateral Internal Carotid Aneurysms in the Petrous Temporal Bones

• Aneurysms of the intrapetrous internal carotid artery are rarely encountered and can present difficult diagnostic problems. A review of the literature revealed 34 cases, and we now add a 35th. Presenting symptoms and signs are dependent on the direction of expansion of the aneurysm, with neurologic dysfunction typical of medial expansion, whereas lateral erosion often suggests a glomus tumor. (Arch Otolaryngol Head Neck Surg1986;112:198-202)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=otol&articleId=612988&pdfFileName=archotol_112_2_018.pdf

Facial Paralysis as the Initial Presentation of an Internal Carotid Artery Aneurysm

Aneurysms of the internal carotid artery in the temporal bone are rare lesions which can present clinically as a growth in the middle ear cleft. Hemorrhage, occurring spontaneously or iatrogenically, is a primary concern. This study describes morphological and embryological characteristics of the internal carotid artery in relationship to the protympanum and temporal bone. Concepts of pathogenesis and pathology are discussed, with reference to the neurosurgical and otolaryngologic literature. Clinical characteristics, including methods of surgical repair, are presented using three illustrative case reports. Methods of surgical repair include: 1) reinforcement; 2) ligation; and 3) primary excision and reanastomosis.

https://journals.sagepub.com/doi/pdf/10.1177/014556139307200704

Carla Jm

Papers

Carotid canal and cavernous sinus aneurysms (a case report).