Clinical features and treatment of endolymphatic sac tumor.

Background: Endolymphatic sac tumor (ELST) is an extremely rare disease that does not have established clinical guidelines.Objective: To provide guidance for the diagnosis and management of ELSTs.Methods: We retrospectively reviewed the medical records of patients who were suspected to have a lesion in the location of endolymphatic sac. Seven patients were included. Histopathologic diagnosis confirmed five ELSTs and two other diseases.Results: All of the enrolled patients had hearing impairment. Facial palsy was found in four out of five patients with ELST, whereas none of the patients in other disease group showed facial palsy. CT and MRI findings were consistent with those in previous literatures; however, angiographic findings were not consistent with those previously reported. All patients underwent surgery. Recurrence occurred in two patients with ELST, although there was no visible remnant tumor after the operation. These patients were treated with stereotactic radiosurgery.Conclusion: Hearing impairment and facial palsy were representative symptoms of ELST. All ELSTs showed 'salt and pepper' signal in MRI T1-weighted images, and smaller tumors could have blood supply from AICA in the radiologic study. Complete surgical resection with optional stereotactic radiosurgery should be considered in ELST.HighlightsHearing impairment and facial weakness are remarkable symptoms of ELST compared to other diseases that invade the endolymphatic sac.All ELSTs showed 'salt and pepper' signal in MRI T1-weighted images.ELST less than 3 cm in diameter could have blood supply from AICA.A complete surgical excision with optional stereotactic radiosurgery is required.

Feasiblity of transoral robotic hypopharyngectomy for early-stage hypopharyngeal carcinoma.

Conventional surgical approaches for hypopharyngeal carcinomas have a great risk for developing treatment-related morbidity. To minimize this morbidity, hypopharyngectomy by transoral robotic surgery (TORS) was performed, and the efficacy and feasibility of this procedure were evaluated. TORS was performed using da Vinci Surgical Robot (Intuitive Surgical Inc., Sunnyvale, CA) in 10 patients with T1 or T2 pyriform sinus cancer and posterior pharyngeal wall cancer. FK retractor (Gyrus Medical Inc., Maple Grove, MN) was used for transoral exposure of the lesion. A face-up 30-degree endoscope was inserted through the oral cavity and two instrument arms were located in both sides of the endoscope. Pyriform sinus was totally resected as a cone-shape from the vallecular to apex region, and ipsilateral arytenoid cartilage was saved for function preservation. The aryepiglottic fold was resected medially. Laterally, the inner perichondrium of the thyroid cartilage was peeled off after perichondrium was incised horizontally to make sure of the safe margin of antero-lateral portion. The posterior margin is an inferior constrictor muscle of the posterior pharyngeal wall. We evaluated the robotic set up time, robotic operation time, blood loss, surgical margins, swallowing time, decannulation time, and surgery related complications. Transoral robotic hypopharyngectomy was performed successfully in all 10 patients. The mean robotic operation time was 62.4min, and an average of 17.5min was required for the setting of the robotic system. There was no significant perioperative complication in the cases. Swallowing function returned to all patients within 8.3days average. Decannulation was carried out within an average of 6.3days after surgery. Transoral robotic hypopharyngectomy was feasible and ontologically safe technique for the treatment of early hypopharyngeal cancer.