title: Aberrant internal carotid artery in the temporal bone: imaging findings and management.
abstract: OBJECTIVE
  To describe the clinical and radiological features of the vascular anomaly aberrant internal carotid artery (ICA) in the temporal bone and to discuss management strategies.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Sixteen cases of aberrant ICA were diagnosed between 1982 and 2003.
  
  
  RESULTS
  Of 16 cases, 11 were recognized by imaging assessment, 4 were recognized during middle ear surgery, and 1 was recognized clinically. Among the 11 cases, 8 malformations were diagnosed because of otologic symptoms related to the abnormal ICA or chronic otitis, while the other 3 were identified incidentally because of an underlying accompanying disease. In 4 cases, the diagnosis was made during surgery related to chronic otitis media (n = 2) or conductive hearing loss (n = 2). In these 4 cases, massive bleeding resulted from surgical injury to the vessel. Packing the external auditory canal and the middle ear first controlled the bleeding. Endovascular procedure was required in 2 cases to exclude an aneurysm or to control bleeding but was followed by anterior cerebral stroke in 1 case. The aberrant ICA could be identified on computed tomographic scan by the following features: intratympanic mass, enlarged inferior tympanic canaliculus, absence of the vertical segment of the ICA canal, and absence of bone covering the tympanic portion of the ICA. Conventional angiography was mandatory when intervention was planned to control bleeding or aneurysm.
  
  
  CONCLUSIONS
  This study highlights that aberrant ICA has to be identified before any middle ear surgery because misdiagnosis may lead to dramatic surgical complications, whereas diagnosis with computed tomographic scan is easy. Bleeding is a minor complication compared with the putative neurologic deficit due to endovascular occlusion.
authors.affiliation: Departments of Otolaryngology and Neuroradiology, Assistance Publique des Hôpitaux de Paris, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Sauvaget
authors.forename: Jérôme
authors.initials: J
authors.lastname: Paris
authors.forename: Sammy
authors.initials: S
authors.lastname: Kici
authors.forename: Romain
authors.initials: R
authors.lastname: Kania
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Guichard
authors.forename: René
authors.initials: R
authors.lastname: Chapot
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Thomassin
authors.forename: Philippe
authors.initials: P
authors.lastname: Herman
authors.forename: Patrice
authors.initials: P
authors.lastname: Tran Ba Huy
mesh_terms: D000328:Adult; D001847:Bone Diseases / Q000175:diagnosis* / Q000601:surgery; D002343:Carotid Artery, Internal; D002828:Choristoma / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013701:Temporal Bone / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods