@article{AJO5199,
author = {Zachary Wilson and Fang Joe Chen and Shannon Culley and Tristan Allsopp},
title = {Cochlear implantation in the presence of a persistent stapedial artery: surgical technique and systematic review},
journal = {Australian Journal of Otolaryngology},
volume = {9},
number = {0},
year = {2026},
keywords = {},
abstract = {Background: Persistent stapedial artery (PSA) is a rare vascular anatomical variant, with an estimated prevalence of 0.02–0.5% in the general population. Although often asymptomatic, its presence during middle ear surgery may obscure anatomical landmarks and increase the risk of intraoperative bleeding. Encountering a PSA during cochlear implantation may complicate identification of the round window and has historically led to abandonment of the procedure. We present a case of successful cochlear implantation in the presence of PSA alongside a systematic review of the literature.Methods: A case report of a 76-year-old male undergoing cochlear implantation with intraoperative identification of a PSA is described. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines using PubMed, Scopus, and Google Scholar up to September 2025. Inclusion criteria comprised case reports or series describing cochlear implantation in the presence of PSA. Data extracted included demographics, surgical approach, radiological findings, intraoperative management, and outcomes.Results: Cochlear implantation was successfully performed via a cochleostomy anterior to the PSA with insertion of an Advanced Bionics HiRes Ultra 3D Slim J electrode array. Postoperatively the patient achieved 100% on closed-set syllabic recognition and 92% on closed-set multisyllable picture identification at switch-on, and 74% on recorded City University of New York (CUNY) sentences presented at 65 dB sound pressure level (SPL) at two months. The systematic review identified 24 articles, of which four met inclusion criteria, representing four previously reported successful implantations. Common radiological features included absent foramen spinosum and abnormal soft tissue traversing the cochlear promontory. No permanent neurological or vascular complications were reported.Conclusions: Although limited evidence suggests cochlear implantation can be performed safely in the presence of PSA, the rarity of reported cases precludes definitive conclusions. Careful preoperative radiological assessment and modified surgical technique allow safe implantation. The literature likely underestimates the true incidence of PSA encountered during cochlear implantation, and further reporting may better define its clinical significance.},
issn = {2616-2792}, url = {https://www.theajo.com/article/view/5199}
}