Abstract
BackgroundSelecting the proper surgical approach for mediastinal tumors in the thoracic outlet is difficult. Video-assisted thoracoscopic surgery is ideal because of the less invasiveness; however, it is often difficult to resect tumors only by video-assisted thoracoscopic surgery due to the poor visualization of the cranial side of tumors. We report two successfully treated cases by using a dual approach consisting of the transmanubrial osteomuscular sparing technique and video-assisted thoracoscopic surgery for aiming both the less invasiveness and the good visualization of the cranial side of tumors.Case presentationsWe present two resected cases of the mediastinal tumor in the thoracic outlet. The first case was a 28-year-old woman and the second case was a 37-year-old man. They had a mediastinal tumor in the thoracic outlet which was detected on the roentgenogram. A definitive preoperative diagnosis was unavailable. The surgical resection was started with video-assisted thoracoscopic surgery in the both cases. After the dissection of the caudal side of the tumor, the dissection of the cranial side was judged to be difficult and risky because the tumor was located adjacent to major vessels and the good visualization of this side couldn’t be acquired. Therefore, the transmanubrial approach was sequentially performed and complete resection was safely achieved. Postoperatively, although transient Horner syndrome appeared in both cases, they recovered from this syndrome and were discharged. The final diagnosis was schwannoma for both cases. Neither of the cases had any functional restriction of the upper extremity.ConclusionsThis dual approach for mediastinal tumors in the thoracic outlet is useful in terms of safety and lower invasiveness.
Highlights
Selecting the proper surgical approach for mediastinal tumors in the thoracic outlet is difficult
For large tumors that are adjacent to major vessels, dissection of the cranial side is sometimes difficult with video-assisted thoracoscopic surgery (VATS); an additional surgical approach by which the good visualization of this
We report two cases of mediastinal tumors in the thoracic outlet that were successfully treated with the dual surgical approach of transmanubrial osteomuscular sparing approach (TMA) and VATS
Summary
Selecting the appropriate surgical approach for mediastinal tumors in the thoracic outlet is sometimes difficult owing to anatomical issues. For large tumors that are adjacent to major vessels, dissection of the cranial side is sometimes difficult with VATS; an additional surgical approach by which the good visualization of this. Dissection of the caudal side could be performed with VATS (Fig. 1c); safe dissection of the cranial side was difficult and risky because of the low mobility of the tumor, poor visualization, difficulty in handling surgical devices and tumor location (adjacent to right subclavian vein and right brachiocephalic artery). Dissection of the caudal side was performed with VATS; the cranial side was judged to be difficult and risky to dissect owing to tumor location, poor visualization and difficulty in handling surgical devices. But he was well without Horner syndrome 1 year postoperatively He had no functional restriction of the left upper extremity
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