Different methods for surgical treatment of ectopic parathyroid in the mediastinum

Abstract

Background Ectopic parat hyroid glands result from aberrant migration during early stages of development. They constitute a common etiology of persistent or recurrent hyperparathyroidism when they are missed at initial diagnosis. Ectopic inferior parathyroid glands are most frequently found in the anterior mediastinum, in association with the thymus or the thyroid gland. Patients and methods and results Eight cases of ectopic parathyroid in the mediastinum underwent surgery with different methods of surgical management. Hyperparathyroidism diagnosis is usually assisted by parathyroid hormone (PTH) measurement in peripheral blood after resection of a suspected adenoma and by frozen section histology. Intraoperative PTH levels are reduced within 10 min. The PTH levels should fall to at least 50% of the preoperative level or time of gland removal concentrations and should be measured at least for 15 min after excision. If they persist, the ectopic gland or multiple-gland disease is suspected. Seven patients with hyperparathyroidism and ectopic parathyroid glands were identified from a parathyroid database. Laboratory data, gland weights, and surgical outcomes were obtained. The locations of the ectopic glands were correlated with results of technetium-99-m-sestamibi-imaging. Of the operated eight patients with ectopic parathyroid glad, 50% in the anterior mediastinum were treated by video-assisted thoracoscopic surgery, 12.5% in middle mediastinum treated by mediastinoscopy, and 37.5% treated by neck exploration. Conclusion All glands were successfully identified preoperatively and subsequently resected. Ectopic mediastinal parathyroid glands may be safely and accurately resected using VATS, and mediastinoscopy, to avoid open approaches.