Download PDF
CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2022; 83(S 03): e665-e666
DOI: 10.1055/s-0042-1757617
Skull Base: Operative Videos

Transotic Approach for Resection of Expansile Endolymphatic Sac Tumor

Ravi S. Nunna 
1   Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United States
,
R Mark Wiet
2   Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois, United States
3   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Richard W. Byrne
3   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
› Author Affiliations
› Further Information
Also available at
 
 PDF Download Permissions and Reprints

Abstract

Objectives and Design Endolymphatic sac tumors (ELSTs) are rare and indolent tumors that arise from the endolymphatic sac in the posterior petrous ridge. We present a video case report illustrating the use of a transotic approach for resection of an expansile ELST.

Setting and Participants A 25-year-old male presented with a multiyear history of worsening left-sided hearing loss, vertigo, and headaches. Otoscopy revealed a red mass behind an intact tympanic membrane. Computed tomography revealed a large, locally aggressive mass centered in the posterior petrous temporal bone. Magnetic resonance imaging demonstrated a heterogeneously enhancing 2.4 × 3.1 × 2.4 cm tumor that exerted mass effect on the cerebellar surface with extension into the jugular foramen, tympanic cavity, internal auditory canal, and cistern of the cerebellopontine angle. A transotic approach was planned to obtain the necessary generous exposure.

Main Outcome Measures and Results Preoperative angiography revealed arterial supply via the ascending pharyngeal and tumor embolization with Onyx was performed. Surgical resection began with a blind-sac closure created from the external auditory canal. The tympanic membrane and malleus were removed and the incustapedial joint was transected. A subtotal petrosectomy was performed for partial tumor exposure. The facial canal and sigmoid sinus were carefully skeletonized and a labrynthectomy was performed. The tumor was resected using a combination of bipolar cautery and blunt and sharp dissection. For closure, an abdominal fat graft was secured with overlying resorbable mesh followed by sequential closure of all skin layers. Histopathologic analysis revealed an ELST.

Conclusion The transotic approach offers wide exposure and facilitates large, complex tumor removal.

The link to the video can be found at https://youtu.be/YvhyN8iVi44.


#

Keywords

transotic - endolymphatic - skull base
Zoom Image
Fig. 1 (A) Preoperative axial T2-weighted magnetic resonance imaging (MRI). (B) Preoperative axial computed tomography (CT). (C) Postoperative T1 + C axial MRI revealed near total tumor resection.

www.thieme.com/skullbasevideos

www.thieme.com/jnlsbvideos


Quality:

#

Conflict of Interest

None declared.

Address for correspondence

Ravi S. Nunna, MD
Department of Neurosurgery, University of Illinois at Chicago
912 S. Wood Street, 451-N Chicago, IL, 60612
United Sates   

Publication History

Received: 31 May 2020

Accepted: 31 August 2022

Article published online:
04 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

   Permissions and Reprints
Zoom Image
Fig. 1 (A) Preoperative axial T2-weighted magnetic resonance imaging (MRI). (B) Preoperative axial computed tomography (CT). (C) Postoperative T1 + C axial MRI revealed near total tumor resection.