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Asaf BB, Bishnoi S, Vardhanpuri H, Pulle MV, Kumar A. Robotic excision of posterior mediastinal neurogenic tumours: Technique and surgical outcomes. J Minim Access Surg 2024; 20:136-141. [PMID: 37282429 PMCID: PMC11095809 DOI: 10.4103/jmas.jmas_151_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/13/2022] [Accepted: 03/21/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Neurogenic tumours are the most common tumours of the posterior mediastinum and account for 75% of the tumours in this region. Till recently, open transthoracic approach has been the standard of care for their excision. Thoracoscopic excision of these tumours is being commonly employed because of lesser morbidity and shorter hospital stay. The robotic surgical system offers a potential advantage over conventional thoracoscopy. We herein report our technique and surgical outcomes of excision of posterior mediastinal tumours using the Da Vinci Robotic Surgical System. MATERIALS AND METHODS We retrospectively reviewed 20 patients who underwent Robotic Portal-Posterior Mediastinal Tumour (RP-PMT) Excision at our centre. The demographic data, clinical presentation, characteristics of the tumour, operative and post-operative variables including, total operative time, blood loss, conversion rate, duration of the chest tube, hospital stay and complications were noted. RESULTS Twenty patients underwent RP-PMT Excision and were included in the study. The median age was 41.2 years. The most frequent presentation was chest pain. Schwannoma was the most common histopathological diagnosis. There were two conversions. The total operative time was 110 min with an average blood loss of 30 mL. Two patients developed complications. The postoperative hospital stay was 2.4 days. With a median follow-up of 36 months (6-48 months), all except patients are recurrence-free, except the patient with malignant nerve sheath tumour who developed local recurrence. CONCLUSION Our study demonstrates the feasibility and safety of robotic surgery for posterior mediastinal neurogenic tumours with good surgical outcomes.
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Affiliation(s)
- Belal Bin Asaf
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sukhram Bishnoi
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Harsh Vardhanpuri
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Mohan Venkatesh Pulle
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Arvind Kumar
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
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Chudacek J, Bohanes T, Szkorupa M, Stasek M, Hanuliak J, Skanderova D, Klos D. Schwannoma of the phrenic nerve. A case report. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024. [PMID: 38533732 DOI: 10.5507/bp.2024.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Neurogenic tumors are the third most common tumors occurring within the mediastinum. Predominantly completely asymptomatic, they are most often found in the posterior mediastinum, although they may also be located, albeit rarely, in the middle mediastinum. Thus, in the cases of tumors localized in the middle mediastinum, schwannomas of the phrenic nerve must always be considered. CASE REPORT In this case, a male patient presented with a tumor of the middle mediastinum. PET/CT scan determined that it was a circumscribed tumor without signs of dissemination. However, due to the tumor's location, a preoperative biopsy of the tumor was not possible. Therefore, the patient underwent videothoracoscopic extirpation of the tumor, including the necessary resection of the phrenic nerve that passed through the centre of the tumor. Subsequent histological analysis definitively confirmed a schwannoma with low proliferative activity. CONCLUSIONS Differential diagnosis of mediastinal tumours is very difficult; however, in the case of circumscribed tumours not invading the surrounding tissues, proceeding to surgical revision, with the complete removal of the tumour, is possible, even without determining the histological nature. Minimally invasive surgical techniques dominate the treatment of neurogenic tumors of the mediastinum; they are associated with minimal complications and allow a rapid return of the patient to their normal activities.
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Affiliation(s)
- Josef Chudacek
- Department of Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Tomas Bohanes
- Department of Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
- Department of General and Chest Surgery, University Hospital Krems, Krems an der Donau, Austria
| | - Marek Szkorupa
- Department of Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Martin Stasek
- Department of Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jan Hanuliak
- Department of Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Daniela Skanderova
- Department of Pathology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Dusan Klos
- Department of Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Zilong M, Jinan Z, Weixin L, Peng W, Wei Z. Comparison of the surgical outcomes of the posterior approach, video-assisted thoracic surgery, and combined approach for thoracic dumbbell tumors based on a new classification: a retrospective study. Neurosurg Rev 2024; 47:29. [PMID: 38167736 PMCID: PMC10761486 DOI: 10.1007/s10143-023-02267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/22/2023] [Accepted: 12/24/2023] [Indexed: 01/05/2024]
Abstract
The appropriate surgical treatment strategy was based on the regions of tumor invasion. There is no classification to aid the surgeon in selection. A retrospective study of the clinical data of patients who underwent resection of thoracic dumbbell tumors at the Neurosurgery and Thoracic Surgery Department of Hospital between January 1, 2016, and December 31, 2021 was conducted. Patient data, images, and surgical outcome data were collected. The thoracic spine was divided into areas A, B, and C with respect to the line through the middle of the intervertebral foramen and the line of the costo-transverse joint lateral margin in the horizontal plane. Type I tumors were located in areas A or A and B, type II tumors were located in areas B or B and C, and type III tumors were located in areas A, B, and C. Fifty-five patients with thoracic dumbbell tumors were surgically treated (mean age, 43.1 years; 22 (40%) female). The patients with type I and III tumors underwent the posterior approach, type III tumors had more bleeding during the operation and longer operation times than type I. Among the patients with type II tumors who underwent video-assisted thoracic surgery and the posterior approach, the posterior group had more bleeding and a longer operation time than the others. The patients with type III tumors underwent the combined approach and the posterior approach; although there was no clear difference in the bleeding volume or operation time, the combined approach group had a lower incidence of complications. The new classification of different types of thoracic dumbbell tumors can simply and effectively guide the selection of surgery.
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Affiliation(s)
- Mao Zilong
- Department of Spine Surgery, Xi'an No 3. Hospital, the Affiliated Hospital of, Northwest University, Xi'an, 710018, Shannxi, China
| | - Zhang Jinan
- Department of Neurosurgery, Tangdu Hospital Affiliated Air Force Medical University, Xi'an, 710000, Shannxi, China
| | - Li Weixin
- Department of Neurosurgery, Tangdu Hospital Affiliated Air Force Medical University, Xi'an, 710000, Shannxi, China
| | - Wang Peng
- Department of Neurosurgery, Tangdu Hospital Affiliated Air Force Medical University, Xi'an, 710000, Shannxi, China
| | - Zuo Wei
- Department of Spine Surgery, Xi'an No 3. Hospital, the Affiliated Hospital of, Northwest University, Xi'an, 710018, Shannxi, China.
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Chauhan S, Rahman F, Dhillon GS, Hewapathirana U, Mongalo M, Chung A. Benign Intrapulmonary Schwannoma With High Uptake on Fluorodeoxyglucose-18 (FDG-18 PET) Presenting as a Pancoast Tumor. Cureus 2023; 15:e37788. [PMID: 37081901 PMCID: PMC10112934 DOI: 10.7759/cureus.37788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 04/22/2023] Open
Abstract
A 46-year-old female patient was diagnosed with a rare and benign intrapulmonary schwannoma, a neurogenic tumor that represents approximately 20% of adult mediastinal tumors, with schwannomas being the most common subtype. The patient was initially asymptomatic; however, after a period of four years, the patient presented with bilateral extremity edema, chronic venous stasis, elevated right ventricular systolic pressure, and a slightly enlarged inferior vena cava. These symptoms were caused by the lung tumor compressing intrathoracic structures. This case highlights the need for early evaluation and proper management of neurogenic tumors to avoid serious symptoms and complications. It also emphasizes the importance of vigilant monitoring and prompt surgery to achieve the best outcome for patients with neurogenic tumors.
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Affiliation(s)
| | - Faraz Rahman
- Internal Medicine, Mountainview Hospital, Las Vegas, USA
| | | | | | - Milliejoan Mongalo
- Internal Medicine, Hospital Corporation of America (HCA) Mountainview, Las Vegas, USA
| | - Arnold Chung
- Cardiothoracic Surgery, Mountainview Hospital, Las Vegas, USA
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Kurland DB, Lau D, Dalle Ore CL, Haddad A, Deviren V, Ames CP. Combined retropleural thoracotomy and posterior spinal approach for thoracic dumbbell Schwannoma: Case series and review of the literature. J Clin Neurosci 2022; 106:173-179. [DOI: 10.1016/j.jocn.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
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Zhang Q, Zhou T, Hou P, Mu W, Wang D, Fang J, Li A. A single-center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors. Thorac Cancer 2022; 14:44-51. [PMID: 36351570 PMCID: PMC9807445 DOI: 10.1111/1759-7714.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To study the feasibility, safety, and efficacy of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors, and summarize the treatment experiences and surgical skills. METHODS A single-center retrospective analysis of 37 patients with pediatric mediastinal neurogenic tumors was conducted. Clinical charactersistics and postoperative complications were all analyzed. RESULTS All the operations were successfully completed. There was no statistically significant difference in tumor diameter between the two groups (p > 0.05). The open surgery group had an average operation time of 96.5 ± 32.38 min, while the thoracoscopic surgery group had an average operation time of 78.3 ± 24.51 min (p < 0.05). The thoracoscopic surgery group had significantly lower intraoperative blood loss than the open surgery group (p < 0.05). In addition, the duration of the postoperative thoracic drainage tube was 5.43 ± 0.76 days in the open surgery group, which was longer than the 2.38 ± 0.87 days in the thoracoscopic surgery group (p < 0.05). Furthermore, the postoperative length of hospital stay was an average of 10.23 ± 1.43 days for the open surgery group, longer than for the thoracoscopic surgery group (4.36 ± 0.87 days) (p < 0.05). CONCLUSIONS Thoracoscopic surgery has several advantages in the treatment of pediatric mediastinal neurogenic tumors and is worthy of clinical popularization and application. For giant mediastinal malignant neurogenic tumors, puncture biopsy and adjuvant chemotherapy can be performed before surgery to lessen the tumor volume and enlarge the operation space, which would reduce bleeding and complications.
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Affiliation(s)
- Qiangye Zhang
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Tingting Zhou
- Thoracic Surgery DepartmentChildren's Hospital Capital Institute of PediatricsBeijingChina
| | - Peimin Hou
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Weijing Mu
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Dongming Wang
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Jun Fang
- Pediatric OrthopaedicsYidu Central Hospital of WeifangWeifangChina
| | - Aiwu Li
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
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Percutaneous Spinal Endoscopic Combined with Thoracoscopic Surgery for Treatment of Thoracic Eden IV Dumbbell Tumors. World Neurosurg 2021; 157:e492-e496. [PMID: 34695611 DOI: 10.1016/j.wneu.2021.10.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Thoracic Eden IV dumbbell tumors are rare conditions characterized by neoplasms that arise from neurogenic elements, with intraforaminal and posterior mediastinal involvement. Surgical resection is commonly performed to treat thoracic Eden IV dumbbell-shaped tumors. The combined thoracic-neurosurgical approach is a routine surgical procedure according to the literature. We present our experience with resection of thoracic Eden IV dumbbell tumors with combined percutaneous spinal endoscopic and thoracoscopic procedures in a single stage. METHODS A retrospective review of 7 patients undergoing spinal endoscopic combined with thoracoscopic surgery for thoracic Eden IV dumbbell tumors was performed in our department between 2017 and 2020. Patient demographics, clinical features, operative reports, and preoperative and postoperative images were reviewed. RESULTS Complete resection was achieved in the 7 cases. The mean operative time was 207 minutes (range, 160-310 minutes), with mean estimated blood loss of 47 mL (range, 20-80 mL). The mean chest drain duration was 3 days (range, 2-4 days), and the mean hospital stay was 7 days (range, 5-8 days). No operative complications were observed. During the follow-up period, there were no obvious complications, tumor recurrence, or spinal instability. CONCLUSIONS Percutaneous spinal endoscopic combined with thoracoscopic surgery for the treatment of Eden IV type thoracic dumbbell tumors is a novel, safe, and effective surgical method that can not only remove tumors inside and outside of the thoracic intervertebral foramen in a single stage but also minimize damage to the normal structure of the spine and help in early recovery.
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Ulas AB, Aydin Y, Eroglu A, Gundogdu B. Comparison of VATS and Thoracotomy Results in Mediastinal Neurogenic Tumors. Eurasian J Med 2021; 53:214-219. [PMID: 35110099 PMCID: PMC9879214 DOI: 10.5152/eurasianjmed.2021.20357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE In this study, we aimed to compare the results of patients who underwent surgery by thoracotomy and Video-assisted thoracoscopic surgery (VATS) in mediastinal neurogenic tumors. MATERIALS AND METHODS Twenty-six consecutive cases (12 males and 14 females; mean age 39.4 ± 22.3 years; range 1-72 years) who were histopathologically diagnosed as having mediastinal neurogenic tumors between January 2000 and August 2020 were included in a single-center, retrospective study. RESULTS There were 5 (19.2%) children and 21 (80.8%) adults. Lesions in all cases were located in the posterior mediastinum. Schwannoma was detected histopathologically in 18 cases (69.2%), and all of these cases were adult patients. Resection was performed by thoracotomy in 14 cases (7 right and 7 left) and 12 cases by thoracoscopy (7 right and 5 left). The mean tumor size was 7.4 ± 1.9 cm (range 5-12 cm) in the thoracotomy group and 4.3 ± 1.9 cm (range 2-7 cm) in the VATS group (P = .001). Mean operative time was 101.7 ± 27.8 min (range 70-150 min) in the thoracotomy group and 77.9 ± 24.3 min (range 60-150 min) in the VATS group (P = .014). Mean postoperative hospital stay was 7.4 ± 4.0 days (range 3-20 days) in the thoracotomy group and 4.7 ± 1.7 days (range 2-7 days) in the VATS group (P = .040). CONCLUSION Most of the mediastinal neurogenic tumors are benign and surgical resection is required in their treatment. With increasing experience, resection can be performed thoracoscopically in most cases.
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Affiliation(s)
- Ali Bilal Ulas
- Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey,Correspondence to: Ali Bilal Ulas
| | - Yener Aydin
- Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Atilla Eroglu
- Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Betul Gundogdu
- Department of Pathology, Atatürk University School of Medicine, Erzurum, Turkey
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Harrison OJ, Bakir A, Chamberlain MH, Nader-Sepahi A, Amer KM. Combined minimally invasive resection of thoracic neurogenic dumbbell tumors: A European case series. Thorac Cancer 2021; 12:2767-2772. [PMID: 34423903 PMCID: PMC8520801 DOI: 10.1111/1759-7714.14122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background Paraspinal tumors are rare neoplasms arising from neurogenic elements of the posterior mediastinum and surgical resection can be challenging. Here, we demonstrate feasibility and outcomes from the first European case series of combined laminectomy and video‐assisted thoracoscopic surgery (VATS) resection of thoracic neurogenic dumbbell tumors. Methods A retrospective review of all combined thoracic dumbbell tumor resections performed at our institution between March 2015 to February 2019 was undertaken. Outcomes included operative time, blood loss, length of stay and recurrence rate. Statistical analysis was performed with SPSS statistics (v26). Values are given as mean ± standard deviation and median ± interquartile range. Results Seven patients were included in the case series and there were no major complications or mortality. Mean tumor size and operative time were 66 (± 35) mm and 171 (± 63) min, respectively. Median blood loss and length of stay were 40 (± 70) ml and four (± 3) days, respectively. One patient required conversion to thoracotomy to remove a tumor of 135 mm in maximal dimension. Histology in all seven cases confirmed schwannoma. There was no disease recurrence at a maximum follow‐up of 54 months. Conclusions Our experience demonstrates favorable operative times, minimal blood loss and short length of stay when dealing with relatively large tumors compared to previous reports. Thoracotomy may be required for tumors exceeding 90 mm and chest drain removal on the operative day can facilitate early mobility and discharge. We advocate a combined, minimally invasive laminectomy and VATS resection as the gold‐standard approach for thoracic neurogenic dumbbell tumors.
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Affiliation(s)
- Oliver J Harrison
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, UK
| | - Adnan Bakir
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Martin H Chamberlain
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, UK
| | - Ali Nader-Sepahi
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
| | - Khalid M Amer
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, UK
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Savu C, Grigorie V, Melinte A, Diaconu C, Iliescu L, Dimitriu M, Balescu I, Bacalbasa N. Giant Intrathoracic Schwannoma: A Case Report. In Vivo 2021; 34:3527-3532. [PMID: 33144463 DOI: 10.21873/invivo.12194] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM Thoracic neurogenic tumors are most frequently located in the posterior part of the mediastinum or on the chest wall, along the intercostal nerves. Schwannomas are very well tolerated for a long period, until the tumor reaches a large size and compression of the neighbouring mediastinal organs, chest wall or spine appears. The purpose of this article was to present a case of a giant right forth intercostal nerve Schwannoma, completely resected by a right antero-lateral thoracotomy. In addition, intrathoracic giant neurogenic tumors are a rarity. CASE REPORT The patient presented with only diminished tolerance to physical activity with no other obvious symptoms. Standard chest radiography revealed a well-defined opacity of subcostal intensity, occupying two thirds of the right hemithorax, forming a common body with the mediastinal shadow. Thoracic computed tomography (CT) identified a 21/11 cm solid mass that compresses the right lung and the right main bronchus with both a solid component and a central liquid area. Open surgery was performed in order to remove the tumor, which was 20.5/12.5/9 cm in size and weighed 1,830 g, well defined, with no invasion of the adjacent organs, having a solid-fibromatous aspect as well as a central necrotic area. The origin of the tumor was confirmed from the posterolateral part of the forth intercostal nerve. Pathology examination and immunohistochemistry confirmed the diagnosis of a benign Schwannoma. CONCLUSION Benign intrathoracic Schwannomas are asymptomatic for long periods and the main therapeutic option is complete surgical resection. The surgical approach, either open or video-assisted is dictated by the localisation of the tumor, local extension and most importantly the size of the neurogenic mass.
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Affiliation(s)
- Cornel Savu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophtisiology, Bucharest, Romania .,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Vasile Grigorie
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophtisiology, Bucharest, Romania
| | - Alexandru Melinte
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophtisiology, Bucharest, Romania
| | - Camelia Diaconu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Laura Iliescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, "Fundeni" Clinical Institute, Bucharest, Romania
| | - Mihai Dimitriu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, "Sf. Pantelimon" Emergency Clinical Hospital, Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, "Ponderas Academic Hospital", Bucharest, Romania
| | - Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, "Fundeni" Clinical Institute, Bucharest, Romania.,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
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11
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Tang J, Zhang D, Xu YY, Xu XK, Wang FH, Zeng JH, Liang JH, Liu W, Li L. Clinical characteristics and therapeutic outcomes of mediastinal neuroblastoma with intraspinal extension: a retrospective study. Transl Pediatr 2021; 10:715-722. [PMID: 34012821 PMCID: PMC8107862 DOI: 10.21037/tp-20-268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Mediastinal neuroblastoma (NB) can invade the spinal canal and result in spinal cord compression. Some patients go on to develop severe spinal deformities after decompression of the spinal cord. The optimal therapeutic strategy for mediastinal NB with intraspinal extension is still unclear. Our study is to assess the therapeutic strategies for such patients. METHODS A total of 77 patients suffered mediastinal tumors with intraspinal extension between March 2015 and Aug 2019 were enrolled in the study. According to the primary therapy, NB were classified into 4 groups: chemotherapy, video-assisted thoracoscopic surgery (VATS)/thoracotomy, neurosurgical decompression, and a combined thoracic-neurosurgical approach. Clinical features, including patient demographics, neurologic recovery and survival rate, were assessed. RESULTS Among the 77 patients suffered mediastinal tumors with intraspinal extension, neurological symptoms were present in 44 patients. Neurological deficits improved in 76.5% of patients who underwent neurosurgical intervention and 50% of the other patients (P=0.094). Compression manifestations of ≤4 weeks duration showed an improved outcome compared to a longer compression time, with complete recovery of neurological function in 60% of patients versus 28.6% for patients with a longer symptom duration (P=0.04). NB constituted 49.4% of the 77 patients. An overall survival rate of 90.0%±9.5% was achieved for patients in the combined thoracic-neurosurgical group, 59.5%±15.0% in the thoracotomy group, 40.0%±29.7% in laminectomy group, and 37.0%±20.2% in the chemotherapy group. Complete regression of the tumor was demonstrated in 80% of combined group, which was greater than that of patients in the other groups (P=0.001). CONCLUSIONS Neurological recovery was correlated with the type of initial treatment and the duration of neurological symptoms. Mediastinal NB with intraspinal extension can be effectively managed with a combined neurosurgical and thoracic surgical approach.
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Affiliation(s)
- Jue Tang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Dan Zhang
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying-Yi Xu
- Department of Anesthesia, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xin-Ke Xu
- Department of Neurosurgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Feng-Hua Wang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jia-Hang Zeng
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiang-Hua Liang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wei Liu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Le Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
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12
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Lacquet M, Moons J, Ceulemans LJ, De Leyn P, Van Raemdonck D. Surgery for mediastinal neurogenic tumours: a 25-year single-centre retrospective study. Interact Cardiovasc Thorac Surg 2021; 32:737-743. [PMID: 33517410 DOI: 10.1093/icvts/ivab002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Mediastinal neurogenic tumours are uncommon and often benign neoplasms mostly located in the posterior mediastinum and usually diagnosed incidentally. We reviewed our results after surgical resection. We compared patient characteristics and tumour nature between children and adults. Differences between thoracoscopic and open approach were analysed. METHODS Departmental thoracic surgical database was queried for primary mediastinal neurogenic tumours resected between 1992 and 2017. Data included demographics, pathology, tumour nature, symptoms, surgical approach and postoperative morbidity/mortality. RESULTS Fifty-one patients (8 children and 43 adults) underwent tumour resection. Pathology revealed nerve sheath tumour in 1 child (12.5%) versus 36 adults (83.7%; P < 0.001) and ganglion cell tumour in 7 (87.5%) versus 5 (11.6%; P < 0.001). Two adults had a paraganglioma. Malignancy was present in 2 children (25%) versus 2 adults (4.6%; P = 0.049). All malignant tumours caused symptoms while most patients with benign tumours (38/47) were asymptomatic (P < 0.001). Surgical approach included thoracotomy, thoracoscopy and cervicotomy (n = 19/31/1) of which 2 were combined neurosurgical approach. All malignant tumours were approached via thoracotomy while the majority of patients with benign tumours (31/47) underwent thoracoscopy (P = 0.007). No significant difference was noted in overall morbidity between thoracoscopic versus open approach (45.2% vs 42.1%; P = 0.83). Hospital stay was significantly shorter following thoracoscopy (7.4 ± 3.3 vs 13.1 ± 9.8 days; P = 0.001). CONCLUSIONS Children carry a higher incidence to present with a malignant tumour originating from ganglion cells while most tumours in adults are benign, originating from the nerve sheath. The majority of patients with mediastinal neurogenic tumours are asymptomatic. Most tumours are amenable for thoracoscopic resection.
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Affiliation(s)
- Mathieu Lacquet
- Surgical Resident, Competence Center for Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE), Catholic University Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE), Catholic University Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE), Catholic University Leuven, Leuven, Belgium
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Galetta D, Spaggiari L. Primary Intrathoracic Neurogenic Tumors: Clinical, Pathological, and Long-Term Outcomes. Thorac Cardiovasc Surg 2020; 69:749-755. [PMID: 32652524 DOI: 10.1055/s-0040-1712499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intrathoracic neurogenic tumors (INTs) are uncommon neoplasms arising from nerve tissues. We report our single-center experience in treating these rare INTs. METHODS Using a prospective institutional database, clinical, surgical, and pathological records of patients receiving resection of INT between May 1998 and June 2018 were analyzed. Survival was calculated by Kaplan-Meier method. RESULTS There were 82 patients (24 females) with an average age of 53 years (29-75 years). Mean diameter was 32 mm (range, 12-68 mm). Histology included 49 schwannomas (11 malignant), 15 neurinomas (2 malignant), 14 neurilemmomas, and 4 paragangliomas. Tumor was located in the posterior mediastinum in 52 patients, in the thoracic inlet in 12, in the anterior mediastinum in 7, in the lung parenchyma in 5, and in the chest wall in 3. In three (3.6%) patients, the tumor showed an intraspinal extension. Symptoms were reported in 51 patients (62.2%) and included cough in 23, dyspnea in 15, neurologic symptoms in 11, and wheezing in 2. Operation was performed by thoracotomy in 42 (51.2%) cases and less invasive technique in 40 (48.8%) cases. Resection was completed in 80 patients (97.6%). Postoperative radiotherapy was administered in two cases. Intraoperative and postoperative mortalities were nil. Morbidity occurred in four patients (4.8%) including two prolonged air leaks, one hemothorax, and one chylothorax. Five-year survival was 97% (mean follow-up, 4.9 years). Malignant tumors had a worse prognosis (p = 0.02). No recurrence occurred during the follow-up neither for malignant nor for benign tumors. CONCLUSION The treatment of choice for INTs is complete resection which will be tailored to tumor size, location, and extension. Long-term prognosis is favorable for benign neurogenic tumors.
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Affiliation(s)
- Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hematology-Oncology-DIPO, University of Milan, Milan, Italy
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14
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Da M, Peng W, Mo X, Fan M, Wu K, Sun J, Qi J, Zhang Y. Comparison of efficacy between video-assisted thoracoscopic surgery and thoracotomy in children with mediastinal tumors: 6-year experience. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:653. [PMID: 31930054 DOI: 10.21037/atm.2019.10.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Video-assisted thoracic surgery (VATS) has been increasingly used in pediatric patients. We evaluated the outcomes of VATS and thoracotomy for pediatric mediastinal tumors. Methods A total of 137 patients who underwent surgery for mediastinal tumors at our department from March 2012 to September 2018 were recruited in this retrospective study. Forty-three patients were treated by VATS and ninety-four underwent thoracotomy (two patients who underwent open surgery were excluded from the study because they were lost to follow-up). Data including demographic information, tumor characteristics, operative time, conversion of surgery, blood transfusion, postoperative hospital stay, mortality and recurrence were collected and compared between the two groups. Results No significant difference was found in gender, age, weight and tumor distribution between the two groups. The number of patients with malignant tumors who underwent thoracotomy was significantly higher than those who received VATS (78.0% vs. 22.0%, P=0.04). Patients received thoracotomy had significantly larger mean tumor diameter than those who underwent VATS (7.6±3.8 vs. 4.4±1.7 cm, P<0.001). The intraoperative transfusion rate in the thoracotomy group was significantly higher than that in the VATS group (67.4% vs. 14.0%, P<0.001), so was the amount of blood transfusion (148.1±150.7 vs. 23.3±61.1 mL, P<0.001). The VATS group had significantly shorter operative time as compared with the thoracotomy group (94.3±40.9 vs. 133.5±72.1 min, P=0.002). During follow-up, local recurrence was found in 8 (8.7%) patients who underwent thoracotomy, and no significant difference was found in local recurrence rate between the two groups. Four patients who underwent thoracotomy died, and no significant difference was found in mortality between two groups. Conclusions Due to less blood transfusion, shorter operative time and postoperative hospital stay, VATS is a safer surgical treatment for pediatric mediastinal tumors than thoracotomy.
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Affiliation(s)
- Min Da
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Wei Peng
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Ming Fan
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Kaihong Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Jian Sun
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Jirong Qi
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Yuxi Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
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15
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Xu X, Zhou X, Gao C, Cui Y. Balloon-assisted thoracoscopic surgery for apex posterior mediastinal benign neurogenic tumor. J Thorac Dis 2019; 11:4018-4020. [PMID: 31656676 DOI: 10.21037/jtd.2019.09.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Xiaohui Xu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xiaoyun Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Chao Gao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Yushang Cui
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
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16
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Surgical treatment of thoracic dumbbell tumors. Eur J Surg Oncol 2019; 45:851-856. [DOI: 10.1016/j.ejso.2018.10.536] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 11/19/2022] Open
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17
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Chen X, Ma Q, Wang S, Zhang H, Huang D. Surgical treatment of posterior mediastinal neurogenic tumors. J Surg Oncol 2019; 119:807-813. [PMID: 30653663 DOI: 10.1002/jso.25381] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/03/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Xiaofeng Chen
- Department of Cardiothoracic SurgeryHuashan Hospital, Fudan UniversityShanghai China
| | - Qinyun Ma
- Department of Cardiothoracic SurgeryHuashan Hospital, Fudan UniversityShanghai China
| | - Shaohua Wang
- Department of Cardiothoracic SurgeryHuashan Hospital, Fudan UniversityShanghai China
| | - Huijun Zhang
- Department of Cardiothoracic SurgeryHuashan Hospital, Fudan UniversityShanghai China
| | - Dayu Huang
- Department of Cardiothoracic SurgeryHuashan Hospital, Fudan UniversityShanghai China
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18
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Li Y, Wang B, Li L, Lü G. Posterior surgery versus combined laminectomy and thoracoscopic surgery for treatment of dumbbell-type thoracic cord tumor: A long-term follow-up. Clin Neurol Neurosurg 2018; 166:31-35. [DOI: 10.1016/j.clineuro.2018.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/06/2018] [Accepted: 01/15/2018] [Indexed: 12/28/2022]
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19
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Kocaturk CI, Sezen CB, Aker C, Kalafat CE, Bilen S, Kutluk AC, Karapinar K, Erdogan S, Saydam O. Surgical approach to posterior mediastinal lesions and long-term outcomes. Asian Cardiovasc Thorac Ann 2017; 25:287-291. [PMID: 28376631 DOI: 10.1177/0218492317705040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Posterior mediastinal lesions are classified as solid lesions and cysts. The treatment for both types is surgery. We evaluated the surgical outcomes and recurrence rates after video-assisted thoracic surgery and thoracotomy for posterior mediastinal lesions. Methods Data of 66 resections for posterior mediastinal masses between 2000 and 2014 were reviewed retrospectively. Twenty-two patients were treated by video-assisted thoracic surgery (group V) and 44 underwent thoracotomy (group T); 29 (43.9%) were female and 37 (56.1%) were male, the mean age was 45.9 ± 14.7 years. Results Bronchogenic cyst was the most common cystic lesion (10/12, 83.3%), and benign schwannoma was the most common solid lesion (32/54, 59.2%). The mean diameter of solid lesions was 5.19 ± 2.4 cm (group V 3.98 ± 1.8 vs. group T 5.78 ± 2.5 cm, p = 0.006). The tumor diameter was 4.06 ± 1.9 cm in asymptomatic patients and 6.93 ± 2.2 cm ( p < 0.001) in symptomatic patients. In group V, hospital stay and duration of drainage were significantly shorter than in group T ( p = 0.02, p = 0.01). Local recurrence was detected in 4 (6.1%) patients. Cystic lesions had a higher recurrence rate than solid lesions ( p = 0.01). There was no significant difference in recurrence rates in groups V and T ( p = 0.59). Conclusion Video-assisted thoracic surgery is a safe method for surgical treatment of posterior mediastinal lesions, with a shorter drainage time and postoperative hospitalization and similar recurrence rates. More recurrences are seen in patients with cystic lesions.
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Affiliation(s)
- Celalettin I Kocaturk
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Celal B Sezen
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cemal Aker
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cem E Kalafat
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Salih Bilen
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali C Kutluk
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kemal Karapinar
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sertan Erdogan
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozkan Saydam
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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20
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Rakovich G, Deslauriers J. Video-assisted and minimally-invasive open chest surgery for the treatment of mediastinal tumors and masses. J Vis Surg 2017; 3:25. [PMID: 29078588 DOI: 10.21037/jovs.2017.01.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/22/2016] [Indexed: 12/31/2022]
Abstract
This article reviews the anatomy of the mediastinum as well as indications, limitations, techniques, and results of video-assisted thoracic surgery (VATS) and other minimally-invasive open-chest surgery approaches currently used for the surgical management of mediastinal tumors and masses. It is written by two surgeons with vastly different backgrounds and thoracic surgical experience. One of them is young and very familiar with VATS approaches and technologies while the other is a senior surgeon relatively unfamiliar with minimally-invasive techniques. This combination of authorship is ideal to analyze the pros and cons of the use of minimally-invasive approaches for the surgical management of mediastinal lesions such as thymic epithelial tumors (TETs) or neurogenic tumors. This is important because several thoracic surgeons have expressed concerns about the ability of thoracoscopic procedures to maintain adherence to sound oncological principles.
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Affiliation(s)
- George Rakovich
- Department of Surgery at the University of Montreal, Montreal, Quebec, Canada
| | - Jean Deslauriers
- Department of Surgery, Laval University, Quebec City, Quebec, Canada
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21
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Laparoscopic-Assisted Resection for Retroperitoneal Dumbbell-Shaped Lumbar Spinal Schwannomas: Operative Technique and Surgical Results. World Neurosurg 2016; 91:129-32. [DOI: 10.1016/j.wneu.2016.03.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 11/22/2022]
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22
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Nanda A, Kukreja S, Ambekar S, Bollam P, Sin AH. Surgical Strategies in the Management of Spinal Nerve Sheath Tumors. World Neurosurg 2015; 83:886-99. [DOI: 10.1016/j.wneu.2015.01.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 01/05/2015] [Accepted: 01/19/2015] [Indexed: 12/01/2022]
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Robotic resection of a superior sulcus neurogenic tumor. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:142-5. [PMID: 25798734 DOI: 10.1097/imi.0000000000000129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurogenic tumors do not often occur in the superior sulcus or apex of the chest cavity. Historically, surgical approaches have been dictated by the location of the tumor and its relation to the contiguous structures such as the vertebral bodies, subclavian vessels, and chest wall. Resection is hampered by difficulties with visualization and access within a narrow working space. The shortcomings associated with the traditional surgical approaches create a potential of injury to nearby structures. We present a case of a 43-year-old woman with a superior sulcus neurogenic tumor impinging on the left subclavian vein, who underwent a successful resection without injury to nearby structures. We found that a robotic approach improved visualization of the tumor and nearby structures and increased instrument maneuverability relative to a thoracoscopic approach, along with less pain and recovery time compared with a thoracotomy. This experience suggests that robotics provides a promising alternative for excision of superior sulcus neurogenic tumors, which may reduce associated morbidity.
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24
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Nguyen DC, Garagozlo C, Moslemi M, Rawashdeh B, Meyer M, Tempesta BJ, Poston R, Gharagozloo F. Robotic Resection of a Superior Sulcus Neurogenic Tumor. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Duy C. Nguyen
- Division of Cardiothoracic Surgery, The University of Arizona Medical Center, Tucson, AZ USA
| | - Cameron Garagozlo
- Division of Cardiothoracic Surgery, The University of Arizona Medical Center, Tucson, AZ USA
| | - Mohammad Moslemi
- Division of Cardiothoracic Surgery, The University of Arizona Medical Center, Tucson, AZ USA
| | - Badi Rawashdeh
- Division of Cardiothoracic Surgery, The University of Arizona Medical Center, Tucson, AZ USA
| | - Mark Meyer
- George Washington University Medical Center, Washington, DC USA
| | - Barbara J. Tempesta
- Division of Cardiothoracic Surgery, The University of Arizona Medical Center, Tucson, AZ USA
| | - Robert Poston
- Division of Cardiothoracic Surgery, The University of Arizona Medical Center, Tucson, AZ USA
| | - Farid Gharagozloo
- Division of Cardiothoracic Surgery, The University of Arizona Medical Center, Tucson, AZ USA
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25
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Ma L, Mei J, Liu L. Thoracoscopic resection of functional posterior mediastinal paraganglioma: a case report. J Thorac Dis 2015; 6:1861-4. [PMID: 25589992 DOI: 10.3978/j.issn.2072-1439.2014.12.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/16/2014] [Indexed: 02/05/2023]
Abstract
A 48-year-old man with posterior mediastinal mass was diagnosed as functional mediastinal paraganglioma during surgical exploration via open thoracotomy in another hospital. The operation was terminated because of severe hypertension when touching the tumor. He was transferred to our center later. After systemic evaluation, the patient was medicated with oral alpha- and beta-blockades, as well as intravenous fluid resuscitation for two weeks. His blood pressure became stable and a second operation was planned. The tumor was removed completely via the thoracoscopic approach, and was finally confirmed as functional paraganglioma by immunohistochemistry. The patient recovered uneventfully after surgery, with no recurrence during one year follow-up visit.
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Affiliation(s)
- Lin Ma
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jianong Mei
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
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Ratbi MB, El Oueriachi F, Arsalane A, El Hammoumi MM, Kabiri EH. Surgery of benign neurogenic tumors in adults: single institution experience. Pan Afr Med J 2014; 19:288. [PMID: 25870743 PMCID: PMC4391890 DOI: 10.11604/pamj.2014.19.288.4929] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/13/2014] [Indexed: 11/11/2022] Open
Abstract
The objective of this work is to review retrospectively our experience with 17 patients presenting with benign neurogenic tumors, managed in the department of thoracic surgery, Mohamed V Military Academic Hospital, Rabat, Morocco. Between 2003 and 2011, seventeen patients were surgically treated for benign neurogenic tumors of the mediastinum, among 112 mediastinal tumors operated during the same period. The mean age of the 17 patients was 46 years, including 11 females and 6 males. The information about clinical presentation, diagnostic procedures, surgical techniques and postoperative follow-up were extracted and analyzed from medical records. Symptoms related to the tumor were found in 13 patients (76,4%). The posterior mediastinum was the principal location (16 cases: 94%). Intraspinal extension was shown through MRI in one case. Surgical extirpation was complete in all patients. There were no tumor-related deaths and no significant complications. There were 13 schwannomas, 2 neurofibromas and 2 ganglioneuromas. Neurogenic tumors of the mediastinum in adults are mostly benign. Their only treatment is surgical extirpation. Video-assisted thoracoscopic resection is currently the best approach in selected patients.
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Affiliation(s)
- Moulay Brahim Ratbi
- Department of Visceral Surgery, Mohamed V Military Academic Hospital, Rabat, Morocco
| | - Fayçal El Oueriachi
- Department of Thoracic Surgery, Mohamed V Military Academic Hospital, Rabat, Morocco
| | - Adil Arsalane
- Department of Thoracic Surgery, Mohamed V Military Academic Hospital, Rabat, Morocco
| | | | - El Hassane Kabiri
- Department of Thoracic Surgery, Mohamed V Military Academic Hospital, Rabat, Morocco
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Quan GMY, Irons S, Scripcaru G, Tang SK. Posterior mediastinal paraspinal angioleiomyoma causing thoracic radiculopathy. ANZ J Surg 2014; 86:100-2. [PMID: 24735193 DOI: 10.1111/ans.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gerald M Y Quan
- Department of Spinal Surgery, The University of Melbourne Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Steven Irons
- MIA Radiology, Frankston Private Hospital, Melbourne, Victoria, Australia
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Verdú-López F, Beisse R. [Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 2: treatment of the thoracic disc hernia, spinal deformities, spinal tumors, infections and miscellaneous]. Neurocirugia (Astur) 2014; 25:62-72. [PMID: 24456908 DOI: 10.1016/j.neucir.2013.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has evolved greatly since it appeared less than 20 years ago. It is currently used in a large number of processes and injuries. The aim of this article, in its two parts, is to review the current status of VATS of the thoracic and lumbar spine in its entire spectrum. DEVELOPMENT After reviewing the current literature, we developed each of the large groups of indications where VATS takes place, one by one. This second part reviews and discusses the management, treatment and specific thoracoscopic technique in thoracic disc herniation, spinal deformities, tumour pathology, infections of the spine and other possible indications for VATS. CONCLUSIONS Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of spinal deformities, spinal tumours, infections and other pathological processes, as well as the reconstruction of injured spinal segments and decompression of the spinal canal if lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in regard to morbidity of the approach and subsequent patient recovery.
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Affiliation(s)
| | - Rudolf Beisse
- Wirbelsäulenzentrum Starnberger See Benedictus Krankenhaus, Tutzing, Alemania
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Preoperative symptoms and postoperative sequelae of intrathoracic neurogenic tumors: a single institution's experience. Gen Thorac Cardiovasc Surg 2013; 61:699-705. [PMID: 23852427 DOI: 10.1007/s11748-013-0285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Most intrathoracic neurogenic tumors are resected for therapeutic diagnosis; many adult tumors are benign. However, few studies have reported the preoperative symptoms, postoperative modalities, and sequelae of these tumors. We focused on and evaluated the diversity and postoperative prognosis of these tumors. METHODS We assessed 31 consecutive cases of intrathoracic neurogenic tumors resected at Tsuchiura Kyodo General Hospital between 1988 and 2012. Two cases involved multiple tumors; therefore, complete resection or enucleation was performed only in the remaining 29 cases. The patients' clinical records were investigated retrospectively. RESULTS All tumors were benign. Five cases (16.1 %) presented with preoperative symptoms; 2 cases with non-neurologic symptoms (dysphagia due to tumor oppression and a massive hemothorax with neurofibromatosis type 1) improved after surgery, but 3 others with neurologic symptoms (back pain, hand motor paralysis, and Horner's syndrome) did not. Ten cases (32.3 %) presented with postoperative modalities or sequelae. Eight cases presented with neurologic sequelae (Horner's syndrome, 4 cases; grip weakness, 3 cases; hypohidrosis, 3 cases; and hand numbness, 2 cases). All the patients presenting with neurologic sequelae had tumors proximal to the first or second thoracic vertebra; no tumors proximal to or under the third thoracic vertebra caused neurologic sequelae. Severe neurologic sequelae in daily life were observed in 2 cases, but they did not radically improve. CONCLUSIONS While the non-neurologic symptoms caused by intrathoracic neurogenic tumors can be resolved by resection, the neurologic symptoms may not improve. Tumors proximal to the first or second thoracic vertebra can cause postoperative neurologic sequelae.
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Fraga JC, Rothenberg S, Kiely E, Pierro A. Video-assisted thoracic surgery resection for pediatric mediastinal neurogenic tumors. J Pediatr Surg 2012; 47:1349-53. [PMID: 22813795 DOI: 10.1016/j.jpedsurg.2012.01.067] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Video-assisted thoracoscopic surgery (VATS) resection of mediastinal neurogenic tumors is still controversial in children. The aim of this study was to review the cases of VATS resection of such tumors in children from 3 institutions located in different countries. METHODS This retrospective study included 17 children treated between July 1995 and February 2011. Medical charts were reviewed for collection of data on age, sex, histologic type of tumor, clinical manifestations, age and weight at surgery, tumor size, duration of thoracic drainage, surgical complications, tumor recurrence, and mortality. RESULTS Thirteen (76.5%) males and 4 (23.5%) females were studied. Median age was 16 months (range, 10.6-60 months), and median weight was 11.9 kg (range, 9.3-27.4 kg). Ten children had neuroblastoma (58.8%), 4 had ganglioneuroma (23.5%), and 3 had ganglioneuroblastoma (17.7%). The median duration of the operation was 90 minutes (range, 45-180 minutes), with complete thoracoscopic resection in all cases. Two children (11.8%) developed Horner syndrome postoperatively. No deaths were reported, and no recurrence was noted during a median follow-up period of 16 months (range, 8.9-28.6 months). CONCLUSIONS Video-assisted thoracoscopic surgery resection of mediastinal neurogenic tumors in children produced good results, with no recurrence and minimal postoperative complications. The major advantages of this approach are the avoidance of thoracotomy complications and the enhanced surgical accuracy provided by improved visualization.
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Affiliation(s)
- Jose Carlos Fraga
- Pediatric Thoracic Surgery Unit/Pediatric Surgery Service, Hospital de Clínicas de Porto Alegre, Porto Alegre RS 90035-903, Brazil.
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Ando K, Imagama S, Wakao N, Hirano K, Tauchi R, Muramoto A, Matsui H, Matsumoto T, Matsuyama Y, Ishiguro N. Single-stage removal of thoracic dumbbell tumors from a posterior approach only with costotransversectomy. Yonsei Med J 2012; 53:611-7. [PMID: 22477007 PMCID: PMC3343420 DOI: 10.3349/ymj.2012.53.3.611] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Thoracic dumbbell tumors are relatively rare, usually arising from neurogenic elements. Methods for surgical removal thereof remain controversial. The purpose of this study was to evaluate the surgical results of a single-stage posterior approach with laminectomy and costotransversectomy only for the management of thoracic dumbbell tumors. MATERIALS AND METHODS Eight cases of thoracic large dumbbell tumor were analyzed retrospectively: seven men and one woman (mean age, 49 years). Pathologic findings included schwannoma in five patients, neurofibroma in two patients (Recklinghausen in one patient), and ganglioneuroma in one patient. All patients underwent single-stage removal of dumbbell tumors by a posterior approach followed by laminectomy and costotransversectomy combined with instrumentation. Clinical and radiologic outcomes were reviewed, thereafter. RESULTS Operative time ranged from 185 to 420 minutes (mean, 313 minutes), with estimated blood loss ranging from 71 to 1830 mL (mean, 658 mL). Postoperative complications included atelectasis in one case. All patients had tumors successfully removed with no neurological deterioration. Spinal deformities were not observed in any patients at the last follow-up (mean, 52 months), with instrumentation. CONCLUSION Single-stage surgery with laminectomy and costotransversectomy may be useful for removing thoracic dumbbell tumors without a combined anterior approach.
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Affiliation(s)
- Kei Ando
- Department of Orthopaedic Surgery, Nagoya Graduate University School of Medicine, 65 Tsurumai Syowa-ward, Aichi 466-8550, Japan.
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Zhang Z, Liu D, Guo Y, Shi B, Tian Y, Song Z, Liang C. Preferred surgical procedure for posterior mediastinal neurogenic tumor. Thorac Cancer 2012; 3:68-71. [PMID: 28920262 DOI: 10.1111/j.1759-7714.2011.00074.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM To compare the outcomes of video-assisted thoracoscopic surgery (VATS) with those of thoracotomy for the removal of posterior mediastinal neurogenic tumors. METHODS Twenty-four patients were enrolled in the VATS group and 29 were enrolled in thoracotomy group between 1996 and 2010. RESULTS When compared with the thoracotomy group, patients in the VATS group had a shorter operation time (90 ± 29 min vs. 136 ± 41 min, P < 0.001), less blood loss (42 ± 12 mL vs. 209 ± 162 mL, P < 0.001), shorter time to extubation and discharge (2.5 ± 0.7 days vs. 3.1 ± 1.0 days, P= 0.027; 3.6 ± 0.6 days vs. 4.1 ± 1.0 days, P= 0.045). CONCLUSION VATS is a safe and effective surgical procedure for posterior mediastinal neurogenic tumors with better outcomes than thoracotomy.
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Affiliation(s)
- Zhenrong Zhang
- Department of Thoracic Surgery, China Japan Friendship Hospital, Ministry of Health of China, Beijing, China
| | - Deruo Liu
- Department of Thoracic Surgery, China Japan Friendship Hospital, Ministry of Health of China, Beijing, China
| | - Yongqing Guo
- Department of Thoracic Surgery, China Japan Friendship Hospital, Ministry of Health of China, Beijing, China
| | - Bin Shi
- Department of Thoracic Surgery, China Japan Friendship Hospital, Ministry of Health of China, Beijing, China
| | - Yanchu Tian
- Department of Thoracic Surgery, China Japan Friendship Hospital, Ministry of Health of China, Beijing, China
| | - Zhiyi Song
- Department of Thoracic Surgery, China Japan Friendship Hospital, Ministry of Health of China, Beijing, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China Japan Friendship Hospital, Ministry of Health of China, Beijing, China
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Ghostine S, Vaynman S, Schoeb JS, Cambron H, King WA, Samudrala S, Johnson JP. Image-Guided Thoracoscopic Resection of Thoracic Dumbbell Nerve Sheath Tumors. Neurosurgery 2011; 70:461-7; discussion 468. [DOI: 10.1227/neu.0b013e318235ba96] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Surgical removal of dumbbell nerve sheath tumors (NSTs) remains challenging because these neoplasms occupy ≥ 2 spinal and extraspinal spaces. The presence of intraspinal extension, tumor dimension, and/or its location within the thoracic cavity have previously made the resection of these types of neoplasms difficult.
OBJECTIVE:
To describe the feasibility of performing minimally invasive thoracoscopic surgery, as facilitated by an image guidance system (IGS), to achieve gross total resection of select dumbbell NSTs located in the thoracic spine.
METHODS:
The 3 cases presented here contained small intraspinal or foraminal components. Preoperative symptoms included Horner syndrome and back and chest wall pain. We used IGS to help guide the complete thoracoscopic resection of select dumbbell NSTs, consisting of extradural, intraforaminal, and paravertebral tumor components, which previously would have been challenging with only a thoracoscopic approach.
RESULTS:
IGS provided continuous intraoperative anatomic orientation to achieve gross total resection in all 3 cases. All surgical and postsurgical outcomes were satisfactory; preoperative symptoms improved or resolved; and no adverse events were observed.
CONCLUSION:
Thoracic dumbbell NSTs that have small intraspinal or foraminal components could be resected thoracoscopically when facilitated by IGS. Image-guided thoracoscopic resection of such dumbbell tumors may not only improve the precision of resection, reduce recurrence, and avoid the need for spinal reconstruction but also obviate the need for more invasive or simultaneous posterior procedures. The IGS enhances the accuracy and safety of 2-dimensional thoracoscopic surgery and may reduce its learning curve.
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Affiliation(s)
- Samer Ghostine
- The Spine Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Shoshanna Vaynman
- The Spine Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - James Scott Schoeb
- The Spine Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Helen Cambron
- The Spine Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wesley A. King
- The Spine Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Srinath Samudrala
- The Spine Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - J. Patrick Johnson
- The Spine Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
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Oizumi H, Kanauchi N, Kato H, Endoh M, Suzuki J, Sadahiro M. Morcellation technique to remove large tumor in thoracoscopic surgery. Ann Thorac Surg 2011; 92:1141-3. [PMID: 21871326 DOI: 10.1016/j.athoracsur.2011.03.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/09/2011] [Accepted: 03/17/2011] [Indexed: 11/25/2022]
Abstract
Extraction of tumors remains a major problem in thoracoscopic surgery. In this study, we used an efficient instrument to morcellate a tumor during thoracoscopic surgery. The cosmetic result of this technique was satisfactory; thus, we suggest that this technique is a reliable option for use during thoracoscopic surgery for benign solid tumors.
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Affiliation(s)
- Hiroyuki Oizumi
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan.
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Ponce FA, Killory BD, Wait SD, Theodore N, Dickman CA. Endoscopic resection of intrathoracic tumors: experience with and long-term results for 26 patients. J Neurosurg Spine 2011; 14:377-81. [DOI: 10.3171/2010.11.spine09718] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Thoracoscopy may be used in place of thoracotomy to resect intrathoracic neoplasms such as paraspinal neurogenic tumors. Although these tumors are rare, they account for the majority of tumors arising in the posterior mediastinum.
Methods
A database was maintained of all patients undergoing thoracoscopic surgery for tumors. The authors analyzed the presenting symptoms, pathological diagnoses, and outcomes of 26 patients (7 males and 19 females, mean age 37.2 years) who were treated for intrathoracic tumors via thoracoscopy between January 1995 and May 2009. Fourteen patients were diagnosed incidentally (54%). Five patients (19%) presented with dyspnea or shortness of breath, 4 (15%) with pain, 1 (4%) with pneumonia, 1 (4%) with hoarseness, and 1 (4%) with Horner syndrome.
Results
Pathology demonstrated schwannomas in 20 patients (77%). Other diagnoses included ganglioneurofibroma, paraganglioma, epithelioid angiosarcoma, benign hemangioma, benign granular cell tumor, and infectious granuloma. One patient required conversion to open thoracotomy due to pleural scarring to the tumor. One underwent initial laminectomy due to intraspinal extension of the tumor. Gross-total resection was obtained in 25 cases (96%). The remaining patient underwent biopsy followed by radiation therapy. The mean surgical time was 2.5 hours, and the mean blood loss was 243 ml. The mean duration of chest tube insertion was 1.3 days, and the mean length of hospital stay was 3.0 days. Cases that were treated in the second half of the cohort were more often diagnosed incidentally, performed in less time, and had less blood loss than those in the first half of the cohort. There was 1 case of permanent treatment-related morbidity (mild Horner syndrome). All previously employed patients were able to return to work (mean clinical follow-up 43 months). There were no recurrences (mean imaging follow-up 54 months).
Conclusions
Endoscopic transthoracic approaches can reduce approach-related soft-tissue morbidity and facilitate recovery by preserving the normal tissues of the chest wall, by avoiding rib retraction and muscle transection, and by reducing postoperative pain. This less invasive approach thus shortens hospital stay and recovery time.
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Fraga JC, Aydogdu B, Aufieri R, Silva GVM, Schopf L, Takamatu E, Brunetto A, Kiely E, Pierro A. Surgical treatment for pediatric mediastinal neurogenic tumors. Ann Thorac Surg 2010; 90:413-8. [PMID: 20667322 DOI: 10.1016/j.athoracsur.2010.04.086] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 04/19/2010] [Accepted: 04/23/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mediastinal neurogenic tumors are relatively rare in children, and controversies persist about the best surgical approach and long-term survival. METHODS With ethics approval we reviewed the case notes of 43 consecutive children (22 boys) operated on for mediastinal neurogenic tumor in two different institutions from March 1998 to June 2009. RESULTS The average age at diagnosis was 3 years (range, 0.6 to 4.7 years). Of the 43 operated tumors, 20 were neuroblastomas (47%), 13 were ganglioneuroblastomas (30%), and 10 were ganglioneuromas (23%). Only 6 (14%) of these tumors were discovered incidentally; the remaining 37 (86%) presented symptomatically: cough (30%), dyspnea (21%), wheezing (11.6%), neurologic spinal compression (7%), dancing eyes syndrome (7%), and Horner syndrome (7%). Tumor resection was undertaken by open operation in 38 cases (88%) and by thoracoscopy in 5 cases (12%). The children operated on by means of thoracoscopy had significantly smaller tumors (p = 0.01) and shorter duration of thoracic drain (p = 0.011) and hospitalization (p = 0.016) than those who were operated on by thoracotomy. There was not any surgical death. Postoperative complications occurred in 11 children (25.6%). Tumor recurrence occurred in 4 children (9.3%) operated on by open surgery, and there were 2 deaths of children with neuroblastoma. The overall survival was 95.4% in an average follow-up of 3.5 years (range, 0.7 to 4.4 years). CONCLUSIONS Surgical resection of children with mediastinal neurogenic tumors treated at two international tertiary hospitals was safe, and the thoracoscopic approach was appropriate for small tumors. The long-term survival was higher when compared with those reported for other primary neurogenic tumor locations.
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Affiliation(s)
- José Carlos Fraga
- Surgical Unit of the Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom.
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Abstract
Primary tumors of the mediastinum and chest wall comprise a diverse group of conditions with a wide range of presentations. A thorough knowledge of thoracic anatomy is essential for appropriate diagnosis and treatment. Given their proximity to critical structures, treatment of these tumors is often challenging. Although surgery is the mainstay of therapy for most mediastinal and chest wall tumors, a multidisciplinary approach is valuable in many cases.
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Affiliation(s)
- Jae Y Kim
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson, 1515 Holcombe Boulevard, PO Box 0445, Houston, TX 77030, USA
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Ng CSH, Yim APC. Technical advances in mediastinal surgery: videothoracoscopic approach to posterior mediastinal tumors. Thorac Surg Clin 2010; 20:297-309. [PMID: 20451139 DOI: 10.1016/j.thorsurg.2010.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Videothoracoscopic approach to posterior mediastinal tumors is a safe operation in experienced hands. This approach produces results comparable to the other conventional surgical techniques for excision. This article describes the operative procedure and summarizes the advantages of this approach.
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Affiliation(s)
- Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T. Hong Kong SAR, China
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Ng CSH, Wong RHL, Hsin MKY, Yeung ECL, Wan S, Wan IYP, Yim APC, Underwood MJ. Recent advances in video-assisted thoracoscopic approach to posterior mediastinal tumours. Surgeon 2010; 8:280-6. [PMID: 20709286 DOI: 10.1016/j.surge.2010.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 05/29/2010] [Accepted: 06/01/2010] [Indexed: 11/17/2022]
Abstract
Minimal invasive video-assisted thoracic surgery can be a safe alternative technique in the assessment, diagnosis and surgical resection of posterior mediastinal tumours. Video-assisted thoracic surgery may be particularly suited for the management of posterior mediastinal tumours as most are benign. Surgical technique continues to evolve from the classic 3-port access in order to tackle more complex tumours positioned at the apical and inferior recesses of the posterior mediastinum. The preoperative identification of dumbbell tumours is important to facilitate arrangements for a single-stage combined resection for both the intra-thoracic and intraspinal tumour. Results from Video-assisted thoracic surgery posterior mediastinal tumour resection are comparable with conventional surgical techniques in terms of symptomatic improvement, recurrence and survival. Video-assisted thoracic surgery approach has been shown to result in less post-operative pain, improved cosmesis, shorter hospital stay, and more rapid recovery and return to normal activities. In over a decade, video-assisted thoracic surgery has gradually matured and is now a promising therapeutic alternative to open approach. In certain selected patients, video-assisted thoracic surgery may be considered the standard of care for conditions of the posterior mediastinum. Recent developments in robotic surgery for the management of mediastinal tumours are promising, however, long-term results are pending.
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Affiliation(s)
- Calvin S H Ng
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China.
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Martins L, Raiser A, Richter R, Braga F, Rappeti J, Oliveira A. Biópsia do miocárdio em cães: acesso minimamente invasivo por cirurgia torácica videoassistida. ARQ BRAS MED VET ZOO 2009. [DOI: 10.1590/s0102-09352009000600004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Realizou-se uma série de biópsias cardíacas em cães para testar o acesso toracoscópico, utilizando-se oito cães sem raça definida, sob condições de manejo e alimentação adequados. A abordagem à cavidade torácica foi feita por meio de cirurgia torácica videoassistida e o instrumental utilizado para remoção do fragmento de miocárdio foi o convencional em lugar das pinças de videocirurgia. A eficácia do procedimento foi confirmada pelo tempo decorrido entre as incisões, a execução da biópsia e a sutura do tórax, com duração média de 15 minutos. A cirurgia torácica videoassistida para biópsias cardíacas foi considerada segura e adequada, minimizando o desconforto pós-operatório dos pacientes submetidos ao acesso torácico.
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Affiliation(s)
| | | | | | - F.V.A. Braga
- Faculdades Itapiranga; Universidade Federal de Pelotas
| | - J.C. Rappeti
- Faculdades Itapiranga; Universidade Federal de Pelotas
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Surgical strategies for managing foraminal nerve sheath tumors: the emerging role of CyberKnife ablation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:242-56. [PMID: 19798517 DOI: 10.1007/s00586-009-1160-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 07/18/2009] [Accepted: 08/30/2009] [Indexed: 12/15/2022]
Abstract
Sixteen Stanford University Medical Center (SUMC) patients with foraminal nerve sheath tumors had charts reviewed. CyberKnife radiosurgery was innovative in management. Parameters were evaluated for 16 foraminal nerve sheath tumors undergoing surgery, some with CyberKnife. Three neurofibromas had associated neurofibromatosis type 1 (NF1). Eleven patients had one resection; others had CyberKnife after one (two) and two (three) operations. The malignant peripheral nerve sheath tumor (MPNST) had prior field-radiation and adds another case. Approaches included laminotomy and laminectomies with partial (three) or total (two) facetectomies/fusions. Two cases each had supraclavicular, lateral extracavitary, retroperitoneal and Wiltze and costotransversectomy/thoracotomy procedures. Two underwent a laminectomy/partial facetectomy, then CyberKnife. Pre-CyberKnife, one of two others had a laminectomy/partial facetectomy, then total facetectomy/fusion and the other, two supraclavicular approaches. The MPNST had a hemi-laminotomy then laminectomy/total facetectomy/fusion, followed by CyberKnife. Roots were preserved, except in two. Of 11 single-operation-peripheral nerve sheath tumors, the asymptomatic case remained stable, nine (92%) improved and one (9%) worsened. Examinations remained intact in three (27%) and improved in seven (64%). Two having a single operation then CyberKnife had improvement after both. Of two undergoing two operations, one had symptom resolution post-operatively, worsened 4 years post-CyberKnife then has remained unchanged after re-operation. The other such patient improved post-operatively, had no change after re-operation and improved post-CyberKnife. The MPNST had presentation improvement after the first operation, worsened and after the second surgery \and CyberKnife, the patient expired from tumor spread. In conclusion, surgery is beneficial for pain relief and function preservation in foraminal nerve sheath tumors. Open surgery with CyberKnife is an innovation in these tumors' management.
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Kan P, Schmidt MH. Minimally Invasive Thoracoscopic Resection of Paraspinal Neurogenic Tumors: Technical Case Report. Oper Neurosurg (Hagerstown) 2008. [DOI: 10.1227/01.neu.0000313118.73941.d7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
The posterior mediastinum is a common location for benign neurogenic tumors. They are frequently asymptomatic but can present with local compressive or neurological symptoms.
Methods:
Thoracoscopy is used increasingly over posterolateral thoracotomy for the removal of these lesions.
Results:
Complete resection of these tumors through a thoracoscopic approach is possible in most cases, but dumbbell tumors present as special challenges, which require a combined thoracoscopic and open posterior approach.
Conclusion:
In this article, we outline the technique of thoracoscopic resection of paraspinal neurogenic tumors through an operative video and a review of the literature to summarize the surgical outcomes of patients with these lesions.
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Affiliation(s)
- Peter Kan
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Meic H. Schmidt
- Spinal Oncology Service, Huntsman Cancer Institute, and Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
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Lacreuse I, Valla JS, de Lagausie P, Varlet F, Héloury Y, Temporal G, Bastier R, Becmeur F. Thoracoscopic resection of neurogenic tumors in children. J Pediatr Surg 2007; 42:1725-8. [PMID: 17923203 DOI: 10.1016/j.jpedsurg.2007.05.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of thoracoscopy in neurogenic tumors in infants and children. MATERIALS AND METHODS From January 2000 to October 2005, 21 patients aged 7 months to 14 years (mean, 6 years) underwent thoracoscopy for tumor resection in 5 French institutions. One 10-mm optical port and 2 operative 5-mm ports were needed. Selective intubation was required for 3 patients aged about 12 years. Tumor was removed with an endoscopic bag in all cases. RESULTS All procedures were completed successfully without any incomplete resection or recurrence. One conversion was necessary because of a huge mass. A chest tube was left for a mean of 2 days for 17 children. Two children had not had any drainage. Two postoperative chylothorax required chest drainage for 12 days. Only 5 of the 6 older patients (mean age, 12 years) needed a patient-controlled analgesia. The mean operative time was about 100 minutes. Hospital stay ranged from 4 to 12 days. Tumors were neuroblastoma or ganglioneuroblastoma in 16 cases and ganglioneuroma in the 5 other cases. CONCLUSION Thoracoscopy for resection of thoracic neurogenic tumors in children is a feasible, safe, and efficient procedure. The surgeon has a better visualization of the tumor and its anatomic connections. Resection can be as complete as an open procedure without having to complicate the operative technique in the same operating time. It avoids cosmetic and functional disorders because of thoracotomy. It allows a good cosmetic resection without spillage.
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Barrenechea IJ, Fukumoto R, Lesser JB, Ewing DR, Connery CP, Perin NI. Endoscopic resection of thoracic paravertebral and dumbbell tumors. Neurosurgery 2007; 59:1195-201; discussion 1201-2. [PMID: 17277682 DOI: 10.1227/01.neu.0000245617.39850.c9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Neurogenic paravertebral tumors are uncommon neoplasms arising from neurogenic elements within the thorax. These tumors may be dumbbell shaped, extending into the spinal canal or exclusively paraspinal. Generally encapsulated, they are located in the posterior mediastinum. In this report, we present our experience in the thoracoscopic resection of these tumors, including surgical technique and potential pitfalls. METHODS A retrospective review of patients undergoing endoscopic surgery for paravertebral tumors was undertaken. Patient demographics, charts, operative reports, and pre- and postoperative images were reviewed. RESULTS Between 1997 and 2004, 13 patients were treated thoracoscopically for paravertebral tumors in our departments. Our population consisted of four men and nine women. The median age was 44.9 years (range, 29-66 yr). Eight patients presented with pain, dyspnea, cough, and weakness. Five patients had tumors found incidentally. Sizes of the tumors varied from 3 to 9 cm. Final pathology included four neurofibromas, eight schwannomas, and one unclassified granular cell tumor. Gross total resection was achieved endoscopically in all cases. Three patients required a hemilaminectomy for resection of the intraspinal dumbbell component of the tumor during the same operation. The mean operative time was 229.5 minutes. The mean estimated blood loss was 371.1 ml. Postoperative morbidities included one each of tongue swelling, ulnar neuropathy, and intercostal hyperesthesia. The mean hospital stay was 2.8 days. CONCLUSION Paravertebral tumors in the posterior mediastinum are amenable to endoscopic removal, even in hard to reach locations. Tumors with intraspinal extension can be removed concurrently by performing a hemilaminectomy, followed by thoracoscopy, without the need for a thoracotomy.
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Affiliation(s)
- Ignacio J Barrenechea
- Minimally Invasive Spine Surgery Center, Department of Neurosurgery, St. Luke's/Roosevelt, and Beth Israel Medical Centers, New York, New York 10019, USA
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Luh SP, Liu HP. Video-assisted thoracic surgery--the past, present status and the future. J Zhejiang Univ Sci B 2006; 7:118-28. [PMID: 16421967 PMCID: PMC1363755 DOI: 10.1631/jzus.2006.b0118] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Accepted: 12/07/2005] [Indexed: 12/20/2022]
Abstract
Video-assisted thoracic surgery (VATS) has developed very rapidly in these two decades, and has replaced conventional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option or a complementary procedure for some other more complex operations. In this paper we will review its development history, the present status and the future perspectives.
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Affiliation(s)
- Shi-ping Luh
- Department of Cardiothoracic Surgery, Taipei Tzu-Chi Medical University Hospital, Taiwan 231, China.
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Endo S, Murayama F, Otani SI, Tetsuka K, Hasegawa T, Sato Y, Sohara Y. Alternative Surgical Approaches for Apical Neurinomas: A Thoracoscopic Approach. Ann Thorac Surg 2005; 80:295-8. [PMID: 15975384 DOI: 10.1016/j.athoracsur.2005.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Revised: 01/25/2005] [Accepted: 02/01/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Neural tumors at the thoracic apex present technical problems for surgeons because of their inaccessibility and postoperative neural complications. Although several approaches offering better accessibility have been proposed, none have become standard. METHODS Between 1976 and 2004, 23 patients, histologically 20 neurilemmomas and three ganglioneuromas, underwent surgical intervention for apical neurinoma. Surgical approaches were in three groups: (1) open thoracotomy, 8 patients; (2) transcervical, 10 patients; and (3) video-assisted thoracoscopy utilizing intracapsular enucleation to preserve important nerves and vessels, 5 patients. Perioperative variables and postoperative neurological complications were reviewed and compared among the groups. RESULTS Operation time and t blood loss in the vessels group were significantly less than in the other groups. Multivariate analysis with the perioperative variables showed the transcervical approach to be an independent predictor for postoperative neurologic complications (p = 0.0029). All patients remain free from recurrence, even in the follow-up period for patients in the vessels group ranging from 6 to 60 months (average, 35 months). CONCLUSIONS Video-assisted thoracoscopic intracapsular enucleation, when an apical neurinoma is benign and well-capsulated, is the optimal treatment to preserve nerve function. Careful follow-up to monitor for recurrence is necessary.
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Affiliation(s)
- Shunsuke Endo
- Division of General Thoracic Surgery, Department of Surgery, Jichi Medical School, Minamikawachi-machi, Tochigi, Japan.
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Nio M, Nakamura M, Yoshida S, Ishii T, Amae S, Hayashi Y. Thoracoscopic Removal of Neurogenic Mediastinal Tumors in Children. J Laparoendosc Adv Surg Tech A 2005; 15:80-3. [PMID: 15772485 DOI: 10.1089/lap.2005.15.80] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the feasibility and advantages of thoracoscopic removal of neurogenic mediastinal tumors (NMTs) in children. METHODS From January 1998 to December 2001, 6 patients, ages 1.1 to 6.8 years (mean, 3.5 years), underwent thoracoscopic removal of NMT. A retrospective study was done to assess the type of anesthesia, conversions to standard thoracotomy, operative time, complications, and the current status of each patient. RESULTS General anesthesia using a Fogarty catheter as an ipsilateral bronchial blocker was utilized. Four 5-mm ports were placed in all patients. All NMTs were successfully removed without a need to convert to standard thoracotomy. The tumor was captured in an extraction bag, fragmented, and then removed through the trocar site, which had been enlarged up to 2.0-2.5 cm in each case. Pathologic diagnosis was neuroblastoma in 1 patient, ganglioneuroblastoma in 2, and ganglioneuroma in 3 patients. The mean operative time was 230 minutes. There was no need for transfusion and no serious complication related to this approach. All patients are alive at the time of writing, without any evidence of tumor recurrence. CONCLUSION All tumors were successfully removed. Thoracoscopic surgery is a feasible, safe, and effective technique in the treatment for children with NMT.
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Affiliation(s)
- Masaki Nio
- Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, 1, Seiryomachi, Aobaku, Sendai, 980-8574, Japan.
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Venissac N, Leo F, Hofman P, Paquis P, Mouroux J. Mediastinal Neurogenic Tumors and Video-Assisted Thoracoscopy. Surg Laparosc Endosc Percutan Tech 2004; 14:20-2. [PMID: 15259580 DOI: 10.1097/00129689-200402000-00005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurogenic mediastinal tumors in adults are generally benign lesions and for this reason are ideal candidates for resection by video-assisted thoracoscopy (VAT). Usual contraindications to VAT are the dimension of the tumor (greater than 6 cm), its position (apex, posterior costodiaphragmatic angle), and/or the presence of intraspinal growth (the so-called "dumbbell tumors"). This study reviewed a single-institution 10-year experience approaching mediastinal neurogenic tumors routinely by VAT, even in cases of the above mentioned contraindications. From January 1992 to December 2002, 15 consecutive mediastinal neurogenic tumors were operated by VAT (11 females, mean age 43 years, range 16-67). Mean operating time was 99 minutes (range 60-180). No conversion thoracotomy was required. The 2 cases of "dumbbell tumor" in this series were treated by laminectomy followed by VAT. Two patients had a Claude-Bernard-Horner syndrome after removal of lesion at the level of T1-T2. Mean postoperative stay was 5.5 days. Histologic diagnosis was schwannoma in 12 cases (Antoni type A in 7 cases, type B in 4 cases, mixed type in 1 case) and neurofibroma in 3 cases. Results from this 10-year experience confirmed that VAT can be the standard approach for neurogenic tumors in adults without negative effect on radicality of resection and safety of the procedure.
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Affiliation(s)
- Nicolas Venissac
- Department of Thoracic Surgery, Pasteur Hospital, University of Nice, France.
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Pons F, Lang-Lazdunski L, Bonnet PM, Meyrat L, Jancovici R. Videothoracoscopic resection of neurogenic tumors of the superior sulcus using the harmonic scalpel. Ann Thorac Surg 2003; 75:602-4. [PMID: 12607692 DOI: 10.1016/s0003-4975(02)04160-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Resection of neurogenic tumors located in the paravertebral sulcus carries a risk of injury to the adjacent nervous structures and also to critical intercostal arteries supplying the anterior spinal artery. To avoid such complications, we have used the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) for the dissection of neurogenic tumors in 2 consecutive patients operated on by videothoracoscopy. The Harmonic Scalpel functions with ultrasonic energy, producing less heat than a regular electrocautery and allows a safer dissection of tumors located in the posterior mediastinum, particularly those located in the superior paravertebral sulcus.
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Affiliation(s)
- François Pons
- Department of Thoracic Surgery, Percy Military Hospital, Clamart, France.
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Kumar A, Kumar S, Aggarwal S, Khilnani GC. Thoracoscopy: the preferred approach for the resection of selected posterior mediastinal tumors. J Laparoendosc Adv Surg Tech A 2002; 12:345-53. [PMID: 12470409 DOI: 10.1089/109264202320884090] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The posterior mediastinum is a common site for neurogenic tumors. These are mostly asymptomatic and detected incidentally during radiologic investigations. However, they occasionally present with compressive or neurologic symptoms. The tumors are mostly benign but can also be malignant. Left untreated, they continue to grow. Therefore, once detected, resection is always advised. Traditionally, resection has been performed by standard posterolateral thoracotomy. More recently, such tumors have been removed thoracoscopically. We report our experience with three such cases and present a comprehensive analysis of cases of thoracoscopic resection of posterior mediastinal neurogenic tumors reported in the English literature to suggest guidelines for their current management.
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Affiliation(s)
- Arvind Kumar
- Departments of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
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