Thoracoscopic removal of neurogenic mediastinal tumors

Abstract

Neurogenic tumors are the most frequent solid mediastinal tumors in children. They are located in the posterior mediastinum and arise from the sympathetic chain in the posterior paravertebral gutter (Lemoine and Montupet 1990). They can be benign or malignant and are usually resected by classic thoracotomy. A minimally invasive endoscopic technique for resection of these tumors can be used in selected cases (Akashi et al. 1997; Hazelrigg et al. 1999). The aim of such an approach is to ensure the same complete resection as with open thoracotomy but to reduce thoracotomy-related morbidity by avoiding muscle transection and rib retraction. There are two minimally invasive ways to proceed. First, there is video-assisted thoracic surgery (VATS) in which video imaging is used for visualization and dissection of the pathology but in which the procedure itself is performed through a minithoracotomy using not only thoracoscopic but also standard surgical instruments; it has the advantage that the specimen is easily removed through the minithoracotomy at the end of the procedure. Second, there is closed videothoracoscopic surgery (CVTS) in which the entire operation is performed through ports, but in which one of the portholes is enlarged at the end of the procedure in order to allow for tumor extraction. © Springer-Verlag Berlin Heidelberg 2008.