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Management of endolymphatic sac tumors: sporadic cases and von Hippel-Lindau disease.
[von hippel-lindau disease]
To
analyze
the
difference
between
the
endolymphatic
sac
tumors
(
ELSTs
)
in
sporadic
cases
and
in
von
Hippel-
Lindau
(
VHL
)
disease
.
Retrospective
case
review
in
a
tertiary
referral
center
.
Fourteen
cases
of
ELST
,
occurring
since
1998
,
were
reviewed
.
We
analyzed
the
initial
symptoms
,
characteristics
of
the
tumor
,
treatment
,
sequelae
,
and
follow-up
for
each
group
.
The
ELSTs
were
sporadic
in
6
cases
and
associated
with
VHL
disease
in
8
cases
.
The
mean
age
at
the
time
of
the
first
surgery
was
26
years
(
range
,
12
-
41
)
.
All
except
two
of
the
patients
presented
with
a
unilateral
tumor
.
The
initial
symptoms
were
hearing
loss
(
n
=
9
)
,
tinnitus
(
n
=
7
)
,
and
/
or
vertigo
(
n
=
5
)
.
Hearing
loss
was
more
prevalent
in
the
sporadic
cases
.
Preoperative
arteriography
was
performed
for
4
patients
,
with
embolization
performed
for
1
patient
.
The
size
of
the
tumor
was
significantly
larger
in
the
sporadic
cases
(
31
.
7
mm
)
than
in
the
cases
of
VHL
disease
(
19
.
3
mm
)
.
The
surgical
approach
was
more
extensive
in
the
sporadic
cases
.
The
surgeons
found
2
types
of
tumors
.
Cystic
tumors
with
massive
bleeding
invading
the
surrounding
structures
(
the
dura
mater
or
jugular
bulb
)
were
more
common
in
the
sporadic
cases
.
Fibrous
tumors
that
infiltrate
the
bone
and
have
moderate
bleeding
were
more
common
in
the
cases
associated
with
VHL
disease
.
Two
patients
with
small
lesions
were
not
operated
on
but
were
followed
for
6
years
without
tumor
growth
.
They
died
of
metastasis
from
gastric
and
kidney
cancer
.
Four
recurrences
occurred
during
the
14
years
of
follow-up
.
Four
facial
palsies
and
8
cases
of
profound
deafness
were
encountered
postoperatively
.
Sporadic
tumors
are
more
aggressive
than
those
associated
with
VHL
disease
.
Complete
surgical
resection
should
be
the
goal
of
treatment
.
Preoperative
angiography
with
embolization
is
recommended
.
In
some
cases
,
embolization
may
be
impossible
,
and
preoperative
or
postoperative
radiotherapy
should
be
discussed
.
Diseases
Validation
Diseases presenting
"facial palsies"
symptom
von hippel-lindau disease
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