The vestibular aqueduct: site of origin of endolymphatic sac tumors.
OBJECTIVE
Although endolymphatic sac tumors (ELSTs) frequently destroy the posterior petrous bone and cause hearing loss, the anatomical origin of these neoplasms is unknown. To determine the precise topographic origin of ELSTs, the authors analyzed the imaging, operative, and pathological findings in patients with von Hippel-Lindau disease (VHL) and ELSTs.


METHODS
Consecutive VHL patients with small (<or= 1.5 cm) ELSTs who underwent resection at the National Institutes of Health were included. Clinical, imaging, operative, and pathological findings were analyzed.


RESULTS
Ten consecutive VHL patients (6 male and 4 female) with 10 small ELSTs (<or= 1.5 cm; 9 left, 1 right) were included. Serial imaging captured the development of 6 ELSTs and revealed that they originated within the intraosseous (vestibular aqueduct) portion of the endolymphatic duct/sac system. Imaging just before surgery demonstrated that the epicenters of 9 ELSTs (1 ELST was not visible on preoperative imaging) were in the vestibular aqueduct. Inspection during surgery established that all 10 ELSTs were limited to the intraosseous endolymphatic duct/sac and the immediately surrounding region. Histological analysis confirmed tumor within the intraosseous portion (vestibular aqueduct) of the endolymphatic duct/sac in all 10 patients.


CONCLUSIONS
ELSTs originate from endolymphatic epithelium within the vestibular aqueduct. High-resolution imaging through the region of the vestibular aqueduct is essential for diagnosis. Surgical exploration of the endolymphatic duct and sac is required for complete resection.
Lonser
Russell R
RR
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1414, USA. lonserr@ninds.nih.gov
Baggenstos
Martin
M
Kim
H Jeffrey
HJ
Butman
John A
JA
Vortmeyer
Alexander O
AO
D000328:Adult; D004428:Ear Neoplasms / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D004712:Endolymphatic Sac / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014723:Vestibular Aqueduct / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006623:von Hippel-Lindau Disease / Q000150:complications