Microsurgical resection of endolymphatic sac tumors

Endolymphatic sac tumors (ELSTs) are benign but are invasive tumors that arise from the endolymphatic duct or sac in the posterior petrous bone. They can occur sporadically but most often are associated with von Hippel-Lindau disease. Despite their benign nature, ELSTs frequently cause irreversible hearing loss and significant vestibulopathy. Routine serial surveillance and refined imaging techniques now permit the detection of small ELSTs, particularly in patients with von Hippel-Lindau disease that still have hearing. We describe the microsurgical technique that we have used for the successful removal of ELSTs, which permits preservation of hearing and amelioration of vestibular symptoms.