Flap Reconstruction and Hyperbaric Oxygen Therapy in the Management of Temporal Bone Osteoradionecrosis in an Endolymphatic Sac Tumor: Case Report

Daipayan Guha; Cynthia Menard; Wayne Evans; Fred Gentili; Gelareh Zadeh

doi:10.1055/s-0031-1284207

Skull Base Reports, Table of Contents

Skull Base Rep 2011; 1(2): 125-128
DOI: 10.1055/s-0031-1284207

Flap Reconstruction and Hyperbaric Oxygen Therapy in the Management of Temporal Bone Osteoradionecrosis in an Endolymphatic Sac Tumor: Case Report

Daipayan Guha¹ , Cynthia Menard² , Wayne Evans³ , Fred Gentili¹ , Gelareh Zadeh¹

¹Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
²Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
³Department of Anesthesia, Hyperbaric Oxygen Medicine Unit, University Health Network, University of Toronto, Toronto, Ontario, Canada

Abstract

ABSTRACT

Endolymphatic sac tumors (ELSTs) are rare neuroectodermal neoplasms arising within the posterior petrous bone. We present a case of a 21-year-old man who presented with a 6-month history of intermittent morning headaches, fatigue, diplopia, and gait ataxia. Imaging and surgical pathology identified an adenocarcinoma of the endolymphatic sac compressing the cerebellum and brain stem. The tumor and multiple metastases were treated with surgery, radiation, and radiosurgery. Following insertion of a ventriculoperitoneal shunt for hydrocephalus, he developed symptomatic tension pneumocephalus secondary to radionecrosis of his petrous bone, requiring flap reconstruction and use of a programmable shunt valve complemented by hyperbaric oxygen (HBO) therapy. We document here a young patient with a rare adenocarcinoma of the endolymphatic sac. This case is unique for its initial presentation without any vestibuloauditory symptoms. Metastatic spread of ELSTs is also rare. While osteoradionecrosis (ORN) of the temporal bone has been reported previously in patients with nasopharyngeal carcinoma, this is the first time it has been presented in the context of an ELST. Tension pneumocephalus is a rare complication of skull base ORN. This is the first reported use of a programmable shunt valve and HBO therapy in the management of tension pneumocephalus.

KEYWORDS

Endolymphatic sac tumor - osteoradionecrosis - hyperbaric oxygen therapy - tension pneumocephalus

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References

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Daipayan Guha

Toronto Western Hospital, 399 Bathurst Street

4W-439, Toronto, ON M5T 2S8

Email: deep.guha@gmail.com