Krings T, Geibprasert S, Cruz JP, et al. Neurovascular Anatomy in Interventional Neuroradiology: A Case based approach. New York, Thieme, 2015. pp. 13-16.
1. In ICA agenesis, APhA reconstitutes in horizontal petrous segment to form "distal ICA" and tympanic artery entering skull through Jacobsen's canal.
2. Symptoms may be absent, or include pulsatile tinnitus, conductive hearing loss, or a pulsatile retrotympanic mass.
3. It can mimic glomus tumor, otosclerosis or AVM. A temporal bone CT can help differentiate as aberrant ICA can show absent vertical segment of carotid canal, and lateral swing called line of Lapowyker beyond vestibular line
4. Persistent stapedial artery exists in 0.5 percent of population and can present as pulsatile mass in middle ear cavity with or without pulsatile tinnitus. Its associated with absent foramen spinosum. It appears as a vessel from petrous ICA supplying the MMA.
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