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Grading system and surgical approaches for endolymphatic sac tumors

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Endolymphatic sac tumors (ELSTs) are rare, low-grade adenocarcinomas arising from the endolymphatic sac. This study aims to present a novel grading system for ELSTs to determine the optimal management strategy.

Methods

We performed a retrospective analysis of 16 patients with 17 ELSTs. The tumor location and involved adjacent neurovascular structures on CT and MRI were selected to establish the grading system.

Results

Based on the novel grading system, grade III a tumors were most common (7/17), followed by grade I (4/17), grade II (3/17), and grade III b (3/17) tumors. Eight advanced ELSTs (grade III a and III b) received an infra-temporal fossa approach, while the other 6 early stage ELSTs (grade I and II) underwent either a retrolabyrinthine approach with posterior petrosectomy or a translabyrinthine approach combined with subtotal temporal bone resection. Hearing preservation was achieved in 2 grade I patients. Postoperative facial nerve function was HB II in 1 grade III a patient who underwent anterior facial nerve transposition and was HB III in 4 advanced patients who received facial nerve grafts with the great auricular nerve or facial-hypoglossal nerve anastomosis. The mean follow-up time was 35.1 months. Two grade III patients and 1 grade II patient had tumor recurrence during follow-up, among whom 1 grade III b patient had two cases of recurrence.

Conclusion

A correct initial diagnosis was established in all patients after meticulous imaging studies. Surgical resection is still the first choice to manage patients with ELSTs. The novel grading system enables surgeons to select tailored surgical approaches. Long-term follow-up is necessary following surgical intervention.

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Data availability

The raw data used to support this study may be available from the corresponding author upon reasonable request.

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Funding

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Author notes

  1. Feitian Li and Yibo Zhang contribute equally to this work.

Authors and Affiliations

  1. Department of Otology and Skull Base Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Rd, Xuhui District, Shanghai, 200031, People’s Republic of China

    Feitian Li, Yibo Zhang, Wei Li, Qianru Wu, Dedi Kong, Xunbei Shi & Chunfu Dai

  2. Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People’s Republic of China

    Feitian Li, Yibo Zhang, Wei Li, Qianru Wu, Dedi Kong, Xunbei Shi & Chunfu Dai

Authors
  1. Feitian Li
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  2. Yibo Zhang
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  3. Wei Li
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Corresponding author

Correspondence to Chunfu Dai.

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Conflict of interest

The authors declare that there is no funding, financial relationships, or conflicts of interest to disclose regarding the publication of this paper.

Ethics approval

This study was approved by the ethics committee of the Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China (2014007).

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All patients signed informed consent forms.

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All patients and authors approved the publication of this study.

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Li, F., Zhang, Y., Li, W. et al. Grading system and surgical approaches for endolymphatic sac tumors. Eur Arch Otorhinolaryngol 278, 1345–1353 (2021). https://doi.org/10.1007/s00405-020-06185-3

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  • DOI: https://doi.org/10.1007/s00405-020-06185-3

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