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Aberrant ICA in the middle ear
1Division of Anatomy, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 020021, Romania. mugurel.rusu@umfcd.ro.
Summary
Aberrant internal carotid artery (a-ICA) in the middle ear is rare but can be injured during ear surgery. Early recognition via imaging is crucial to prevent severe bleeding and neurological damage.
Area of Science:
- Otolaryngology
- Vascular Anatomy
- Embryology
Background:
- Aberrant internal carotid artery (a-ICA) in the middle ear is a rare congenital anomaly.
- It arises from agenesis of the first embryonic segment of the internal carotid artery.
- a-ICA can be inadvertently injured during otological procedures.
Purpose of the Study:
- To review the embryological basis, clinical presentation, diagnosis, and management of a-ICA.
- To highlight the importance of preoperative recognition to prevent iatrogenic injury.
Main Methods:
- Systematic review of 48 publications.
- Analysis of embryological basis, clinical features, diagnostic imaging, and treatment strategies.
Main Results:
- Hearing loss (47.7%) and pulsatile tinnitus (30.0%) are common symptoms.
- High-resolution computed tomography (HRCT) is key for diagnosis, showing absence of the carotid canal and enlarged inferior tympanic canaliculus.
- Distinguishing a-ICA from petrous ICA variants is important.
Conclusions:
- Preoperative identification of a-ICA is essential to avoid surgical complications.
- Endovascular treatment may have fewer complications than surgical ligation for iatrogenic injuries.
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