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European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 11, pp 3883–3892 | Cite as

Prevention and management of vascular complications in middle ear and cochlear implant surgery

  • Filippo Di LellaEmail author
  • Maurizio Falcioni
  • Silvia Piccinini
  • Ilaria Iaccarino
  • Andrea Bacciu
  • Enrico Pasanisi
  • Davide Cerasti
  • Vincenzo Vincenti
Otology

Abstract

The objective of this study is to illustrate prevention strategies and management of vascular complications from the jugular bulb (JB) and internal carotid artery (ICA) during middle ear surgery or cochlear implantation. The study design is retrospective case series. The setting is tertiary referral university hospital. Patients were included if presented pre- or intraoperative evidence of high-risk anatomical anomalies of ICA or JB during middle ear or cochlear implant surgery, intraoperative vascular injury, or revision surgery after the previous iatrogenic vascular lesions. The main outcome measures are surgical outcomes and complications rate. Ten subjects were identified: three underwent cochlear implant surgery and seven underwent middle ear surgery. Among the cochlear implant patients, two presented with anomalies of the JB impeding access to the cochlear lumen and one underwent revision surgery for incorrect positioning of the array in the carotid canal. Subtotal petrosectomy was performed in all cases. Anomalies of the JB were preoperatively identified in two patients with attic and external auditory canal cholesteatoma, respectively. In a patient, a high and dehiscent JB was found during myringoplasty, while another underwent revision surgery after iatrogenic injury of the JB. A dehiscent ICA complicated middle ear effusion in one case, while in another case, a carotid aneurysm determined a cholesterol granuloma. Rupture of a pseudoaneurysm of the ICA occurred in a child during second-stage surgery and required permanent balloon occlusion without neurological complications. Knowledge of normal anatomy and its variants and preoperative imaging are the basis for prevention of vascular complications during middle ear or cochlear implant surgery.

Keywords

Cochlear implant Middle ear surgery Complications Vascular Jugular bulb Internal carotid artery 

Notes

Compliance with ethical standards

Funding

No funding sources were used for this study.

Conflict of interest

The authors (F. Di Lella, M. Falcioni, I. Iaccarino, S. Piccinini, A. Bacciu, E. Pasanisi, D. Cerasti, and V. Vincenti) declare no conflict of interest.

Ethical statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Koesling S, Kunkel P, Schul T (2005) Vascular anomalies, sutures and small canals of the temporal bone on axial CT. Eur J Radiol 54(3):335–343CrossRefPubMedGoogle Scholar
  2. 2.
    Schutt C, Dissanaike S, Marchbanks J (2013) Case report: inadvertent carotid artery injury during myringotomy as a result of carotid artery dehiscence. Ear Nose Throat J 92(7):E35–E37PubMedGoogle Scholar
  3. 3.
    Takano K, Wanibuchi M, Ito F, Himi T (2016) Pseudoaneurysm of an aberrant internal carotid artery in the middle ear caused by myringotomy. Auris Nasus Larynx 43(6):698–701CrossRefPubMedGoogle Scholar
  4. 4.
    Welling DB, Glasscock ME 3rd, Tarasidis N (1993) Management of carotid artery hemorrhage in middle ear surgery. Otolaryngol Head Neck Surg 109(6):996–999CrossRefPubMedGoogle Scholar
  5. 5.
    Atmaca S, Elmali M, Kucuk H (2014) High and dehiscent jugular bulb: clear and present danger during middle ear surgery. Surg Radiol Anat 36(4):369–374CrossRefPubMedGoogle Scholar
  6. 6.
    Kuhn MA, Friedmann DR, Winata LS, Eubig J, Pramanik BK, Kveton J, Kohan D, Merchant SN, Lalwani AK (2012) Large jugular bulb abnormalities involving the middle ear. Otol Neurotol 33(7):1201–1206CrossRefPubMedGoogle Scholar
  7. 7.
    Moore PJ (1994) The high jugular bulb in ear surgery: three case reports and a review of the literature. J Laryngol Otol 108(9):772–775CrossRefPubMedGoogle Scholar
  8. 8.
    Bilgen C, Kirazli T, Ogut F, Totan S (2003) Jugular bulb diverticula: clinical and radiologic aspects. Otolaryngol Head Neck Surg 128(3):382–386CrossRefPubMedGoogle Scholar
  9. 9.
    Moreano EH, Paparella MM, Zelterman D, Goycoolea MV (1994) Prevalence of carotid canal dehiscence in the human middle ear: a report of 1000 temporal bones. Laryngoscope 104(5 Pt 1):612–618CrossRefPubMedGoogle Scholar
  10. 10.
    Friedmann DR, Eubig J, McGill M, Babb JS, Pramanik BK, Lalwani AK (2011) Development of the jugular bulb: a radiologic study. Otol Neurotol 32(8):1389–1395CrossRefPubMedGoogle Scholar
  11. 11.
    Moret J, Delvert JC, Lasjaunas P (1982) Vascularization of the ear: normal variations, glomus tumors. J Neuroradiol 9(3):209–260PubMedGoogle Scholar
  12. 12.
    Young RJ, Shatzkes DR, Babb JS, Lalwani AK (2006) The cochlear–carotid interval: anatomic variation and potential clinical implications. AJNR Am J Neuroradiol 27(7):1486–1490PubMedGoogle Scholar
  13. 13.
    Lin YY, Wang CH, Liu SC, Chen HC (2012) Aberrant internal carotid artery in the middle ear with dehiscent high jugular bulb. J Laryngol Otol 126(6):645–647CrossRefPubMedGoogle Scholar
  14. 14.
    Brodish BN, Woolley AL (1999) Major vascular injuries in children undergoing myringotomy for tube placement. J Otolaryngol 20(1):46–50CrossRefGoogle Scholar
  15. 15.
    Hough JV (1963) Problems in stapedial surgery. Trans Indiana Acad Ophthalmol Otolaryngol 46:9–17PubMedGoogle Scholar
  16. 16.
    Henriksen SD, Kindt MW, Pedersen CB, Nepper-Rasmussen HJ (2000) Pseudoaneurysm of a lateral internal carotid artery in the middle ear. Int J Pediatr Otorhinolaryngol. 52(2):163–167CrossRefPubMedGoogle Scholar
  17. 17.
    Sanna M (2003) Middle ear and mastoid microsurgery. Thieme, New YorkCrossRefGoogle Scholar
  18. 18.
    Free RH, Falcioni M, Di Trapani G, Giannuzzi AL, Russo A, Sanna M (2013) The role of subtotal petrosectomy in cochlear implant surgery–a report of 32 cases and review on indications. Otol Neurotol 34(6):1033–1040CrossRefPubMedGoogle Scholar
  19. 19.
    Vincenti V, Pasanisi E, Bacciu A, Bacciu S (2014) Long-term results of external auditory canal closure and mastoid obliteration in cochlear implantation after radical mastoidectomy: a clinical and radiological study. Eur Arch Otorhinolaryngol 271(8):2127–2130CrossRefPubMedGoogle Scholar
  20. 20.
    Di Lella F, Falcioni M. Subtotal petrosectomy in middle ear and lateral skull base surgery. In: Takahashi (ed) Cholesteatoma and ear surgery—an update proceedings of the 9th international conference on cholesteatoma and ear surgery. June 3–7, 2012, Nagasaki, Japan (ISBN 13: 978-90-6299-237-9) Google Scholar
  21. 21.
    Pasanisi E, Vincenti V, Bacciu A, Guida M, Berghenti T, Barbot A, Zini C, Bacciu S (2002) Multichannel cochlear implantation in radical mastoidectomy cavities. Otolaryngol Head Neck Surg 127(5):432–436CrossRefPubMedGoogle Scholar
  22. 22.
    Vincenti V, Pasanisi E, Bacciu A, Bacciu S, Zini C (2014) Cochlear implantation in chronic otitis media and previous middle ear surgery: 20 years of experience. Acta Otorhinolaryngol Ital 34(4):272–277PubMedPubMedCentralGoogle Scholar
  23. 23.
    Sanghvi A, Bauer B, Roehm PC (2016) Hemostasis in otologic and neurotologic surgery. Otolaryngol Clin North Am 49(3):749–761CrossRefPubMedGoogle Scholar
  24. 24.
    Sanna M, Shin SH, De Donato G, Sivalingam S, Lauda L, Vitullo F, Piazza P (2011) Management of complex tympanojugular paragangliomas including endovascular intervention. Laryngoscope 121(7):1372–1382CrossRefPubMedGoogle Scholar
  25. 25.
    Piazza P, Di Lella F, Bacciu A, Di Trapani G, Ait Mimoune H, Sanna M (2013) Preoperative protective stenting of the internal carotid artery in the management of complex head and neck paragangliomas: long-term results. Audiol Neurootol 18(6):345–352CrossRefPubMedGoogle Scholar
  26. 26.
    Sahni D, Singla A, Gupta A, Gupta T, Aggarwal A (2010) Relationship of cochlea with surrounding neurovascular structures and their implication in cochlear implantation. Int J Pediatr Otorhinolaryngol 74(6):701–703CrossRefGoogle Scholar
  27. 27.
    Saleh EA, Aristegui M, Taibah AK, Mazzoni A, Sanna M (1994) Management of the high jugular bulb in the translabyrinthine approach. Otolaryngol Head Neck Surg 110(4):397–399CrossRefPubMedGoogle Scholar
  28. 28.
    Nevoux J, Loundon N, Leboulanger N, Roger G, Ducou Le Pointe H, Garabédian EN (2015) Cochlear implant in the carotid canal. Case report and literature review. Surg Radiol Anat 37(8):913–919CrossRefGoogle Scholar
  29. 29.
    Gastman BR, Hirsch BE, Sando I, Fukui MB, Wargo ML (2002) The potential risk of carotid injury in cochlear implant surgery. Laryngoscope 112(2):262–266CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Otolaryngology and Otoneurosurgery DepartmentAzienda Ospedaliero-Universitaria di ParmaParmaItaly
  2. 2.The Neuroradiology DepartmentAzienda Ospedaliero-Universitaria di ParmaParmaItaly

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