Two Consecutive Cases of Persistent Stapedial Artery Managed With a Carbon Dioxide Laser.

OBJECTIVE

(1) Discuss the presentation and management of persistent stapedial artery (PSA) discovered incidentally during cholesteatoma surgery. (2) Review use of carbon dioxide (CO2) laser for treatment of PSA in the setting of chronic ear disease.

PATIENTS: Two consecutive patients with PSA and primary acquired cholesteatoma.

INTERVENTION(S): Tympanomastoidectomy using a canal wall reconstruction technique.

MAIN OUTCOME MEASURE(S): Surgical healing, collateral damage to surrounding anatomy, and postoperative hearing.

RESULTS

Persistent stapedial artery was detected incidentally in 2 patients, manifesting with heavy pulsatile bleeding arising during dissection of mesotympanic cholesteatoma. Preoperative computed tomography scans demonstrated absent foramen spinosum but no other aberrant vascular anatomy. Using CO2 laser, the PSAs were ablated and controlled, allowing complete resection of cholesteatoma and successful completion of the procedure. In both patients, surrounding anatomical structures suffered no iatrogenic injury. Postoperatively, no significant complications occurred. To date, neither patient has demonstrated evidence of recidivistic cholesteatoma.

CONCLUSIONS

A CO2 laser can be useful for managing a PSA in the setting of chronic ear disease.