Intracapsular Enucleation Research Articles

Intracapsular Enucleation of Cervical Sympathetic Chain Schwannoma: Improved Strategy of Intraoperative Hemostasis and Better Outcome.

Objective: Intracapsular enucleation (ICE) of cervical sympathetic chain schwannoma (CSCS) is associated with technical difficulties, with diffuse hemorrhage being the main challenge in our previous attempts. This article presents our new strategy for achieving better hemostasis during ICE procedures in CSCS cases. Methods: A retrospective review of CSCS cases treated at our tertiary medical institution was undertaken between April 2018 and February 2024. Only cases with successful ICE were included. Results: A total of 8 cases were included, with 4 male and 4 female patients and an age range of 23 to 77 (average and median ages were 48.5 and 49.5 years, respectively). The presenting symptom was a neck mass for all the patients, with 4 masses on the left and 4 on the right sides. Enucleation was first undertaken for the first 3 cases (before March 2022), followed by hemostasis; this strategy was quite difficult and time-consuming. For the remaining 5 cases, a new strategy was developed to preemptively manage any potential nourishing vessel between the capsule and tumor parenchyma, which significantly decreased operation time (P = .0155) and facilitated hemorrhage control. First bite syndrome (FBS) was avoided in all cases. Postoperative Horner's syndrome (HS) was avoided in 1 patient (Case 6, new strategy) but occurred in 7 patients, taking 8 days to 1 month to recover with the new strategy (4 patients), significantly shorter (P = .0364) than before (3 patients, 1-3 months). The median duration of follow-up was 20 months. No recurrence was documented. Conclusions: ICE was achieved for CSCS cases, especially with our newly developed strategy, by preemptively and securely managing potential nourishing vessels. Operation time and duration of recovery of postoperative HS could both be shortened. Moreover, FBS could be avoided.

Intracapsular Enucleation of Brachial Plexus Schwannoma With Intraoperative Neuromonitoring: A Case Series Study and a Review of Literature.

Brachial plexus schwannoma (BPS) is a rare clinical entity that poses a significant challenge for head and neck surgeons due to its neuroanatomical complexity and potential severe complications, such as major motor or sensory neurological deficits or pain of the corresponding upper extremity. This article summarizes our experience in its diagnosis and intracapsular enucleation with intraoperative neuromonitoring (INM). A retrospective review of BPS cases treated at our tertiary medical institution was conducted between April 2020 and May 2023. The clinical and demographic data were retrieved from case notes. Totally, 3 cases were included. All 3 patients were male, aged 43 to 54 years (median age = 52). The presenting symptom was a palpable supraclavicular mass in all these cases (2 on the left side and 1 on the right side). Neuromonitoring was performed with a 4-channel nerve integrity monitor, with the electrodes placed in the upper arm and forearm muscles, as demonstrated in the literature. After exposing the mass and identifying its origin from the brachial plexus, a unipolar stimulating probe was used to stimulate the tumor surface or the nerves with a 1.0-mA current, and a longitudinal incision into the tumor capsule was made along a carefully mapped line with no INM response. Then the mass was carefully exposed and meticulously dissected from its capsule to achieve an intact enucleation. Immediate postoperative neurological deficit was documented in Case 1 as a mild grasping weakness. The recovery of the other 2 patients was uneventful. The follow-up duration was 7 to 38 months (median = 8 months). The minor motor deficit of Case 1 recovered completely 1 month after surgery. No recurrence of BPS was observed. Intracapsular enucleation with INM could result in complete removal of BPS and minimal postoperative neurological deficit, whose recovery was quick and satisfactory.

CAROTID SPACE TUMOUR – SCHWANNOMA

The cervical schwannoma is very rare but benign mass lesion. It often results in nonspecic clinical presentations requiring surgical ablation. Surgical indications should be based carefully on the balance between risks and benets. Intracapsular enucleation seems to give good results without much complications and recurrence is rare. Reporting case of schwannoma which at rst stance seems to be having features of typical carotid body tumour but on histopathology it is seen as Schwann cell tumour arising in left carotid space

Intracapsular Enucleation of Cervical Sympathetic Chain Schwannoma.

Schwannoma arising from cervical sympathetic chain (CSC) is a rare clinical entity. CSC is hard to preserve in CSC schwannoma (CSCS) surgeries, resulting in Horner's syndrome (HS) and first bite syndrome (FBS). This article aims to explore our experience in successful preservation of CSC in CSCS surgeries. This is a retrospective review of CSCS cases treated at our tertiary medical institution between Apr 2018 and March 2022. Only cases with successful intraoperative preservation of CSC were included. In total, 3 cases were included. There were 2 male patients and 1 female patient. Their age was between 38years old and 66years old (average and median age was 52 and 51 years old, respectively). Presenting symptom was neck mass for all them, 2 of which were on the left side, while 1 was on the right. Intracapsular enucleation of the CSCS was attempted and achieved in all 3 cases. Hemorrhage from the inner surface of capsules was diffuse and heavy. Constant saline irrigation, suction, and bipolar coagulation were needed to achieve hemostasis. Postoperative HS presented between 4hours and 14 hours after surgery for all 3 patients, which took 1 month to 3months to recover, whereas FBS did not occur in any patient. Median duration of follow-up was 6 months. No recurrence was observed. Intracapsular enucleation should be attempted in CSCS surgeries, although hemorrhage might be diffuse and hard to control. When intracapsular enucleation was achieved, postoperative FBS can be avoided, while postoperative HS could occur, but its recovery was satisfactory.

Intracapsular enucleation of cervical schwannomas via retroauricular hairline incision

IntroductionCervical schwannomas are rare diseases treated by complete resection, leading to potential neurological deficits. Intracapsular enucleation is an acceptable alternative to preserve the involved nerve function, but the clinical outcomes by an aesthetically pleasing approach remain unrevealed. This study evaluated functional and oncological outcomes after intracapsular enucleation of cervical schwannomas via retroauricular hairline (Roh's) incision. Materials and methodsThis prospective observational study included 17 patients with cervical schwannomas who underwent intracapsular enucleation to preserve the involved nerve and capsule via Roh's incision. Each patient was evaluated with any complications, nerve function, subjective satisfaction, voice and swallowing questionnaires, and local recurrence. ResultsIntracapsular enucleation via the Roh's incision was successfully applied to all patients for a median operation time of 48 min. Tumours of 4.5-cm median size were removed with the minimization of injury to the nerve and sheath deflected on the surface of the tumour. Temporary and permanent paralysis of the unilateral vocal fold was found in 3 (33%) and none of 9 patients with vagal schwannomas, respectively. Horner's syndrome occurred temporarily in two of 5 (40%) patients with sympathetic chain schwannomas. Postoperative complications were minor. Subjective satisfaction of scar and facial deformity was high, and subjective voice and swallowing difficulties were minimal one year after surgery. No recurrence was found in the patients for a median follow-up of 82 months. ConclusionIntracapsular enucleation via Roh's incision is a viable treatment for cervical schwannomas with the highest functional, cosmetic, and oncological outcomes.

Intracapsular Enucleation of Intraparotid Facial Nerve Schwannoma with Intratemporal Extension.

Intraparotid facial nerve schwannoma is a rare condition, which is difficult to preoperatively diagnose without a definite biopsy, yet the diagnosis is important for surgical planning and avoiding accidental injury to the facial nerve. Considering the benign indolent nature of the schwannomas, the management should be prioritized on the long-term tumor control with special attention to the facial nerve function and facial cosmesis. Microscope-assisted intracapsular enucleation is an excellent treatment option for such lesions. Our patient showed House–Brackmann grade II facial function after the surgery. This technique is safe and offers a favorable outcome of facial nerve function.

A rare lesion of the wanderer’s nerve with an unusual postoperative complication: vagal nerve schwanomma

<p class="abstract">Vagal nerve schwannomas are rare parapharyngeal tumours which was first described by Figi in 1933. Hoarseness is the most common symptom. Occasionally, a paroxysmal cough may be produced on palpating the mass. This is a clinical sign, unique to vagal schwannoma. Presence of this sign, along with a mass located on the medial border of the sternocleidomastoid muscle, should make clinicians suspicious of vagal nerve sheath tumours. However, in our case, the patient presented to us with a swelling in the neck and no other symptoms. MRI in the pre-operative work-up is helpful in defining diagnosis and in evaluating the extent and the relationship. A careful intracapsular enucleation with nerve-sparing technique remains the treatment of choice in order to avoid nerve injury which can lead to vocal cord paralysis. Horner’s syndrome following cervical surgeries is a rare phenomenon. Its occurrence following excision of a vagal schwannoma can occur due to direct injury to cervical sympathetic chain during excision or indirect injury due to traction on the sympathetic chain. Here is a case report of a patient diagnosed with left vagal scwanomma who developed horner’s syndrome post operatively.</p>

Schwannoma in the extremity: clinical features and microscopic intra-capsular enucleation.

Objective: Schwannomas are the most common type of neoplasm of the peripheral nerves. Enucleation is a standard surgical procedure; however, it occasionally results in iatrogenic nerve injury, even with atraumatic procedures. Herein, we present the clinical characteristics of schwannoma arising in the extremities and discuss the clinical outcomes of extra- and intra-capsular enucleation.Patients and Methods: We reviewed 122 schwannomas treated at our institute. Schwannomas arising from the minor nerve (n=30) or intramuscularly (n=15) were operated using the extra-capsular technique. Of the 77 major nerve schwannomas, 62 schwannomas were treated using the intra-capsular technique and 15 schwannomas using the extra-capsular technique.Results: Neurological deficits following enucleation were significantly lower using the intra-capsular technique than with the extra-capsular technique. The patient age, duration of symptoms, maximum tumor diameter, and site of occurrence were not associated with subsequent neurological deficits. With both techniques, no tumor recurrence was observed at the final follow-up.Conclusion: These results support the use of intra-capsular micro-enucleation as a safe and reliable treatment for every type of schwannoma. To minimize the risk of nerve injury, en bloc resection should not be used because the main purpose of schwannoma surgery is the relief of symptoms, not tumor resection.

Availability of beaver-knife for intra-capsular enucleation of facial nerve schwannoma

Availability of beaver-knife for intra-capsular enucleation of facial nerve schwannoma

Surgical strategies for peripheral nerve schwannoma based on the intraoperative neurophysiological monitoring

ObjectiveTo present our classification for peripheral nerve schwannomas as well as explore the surgical strategies and operative management of peripheral nerve schwannomas based on the intraoperative neurophysiological monitoring (INM) technique and to decrease the risk of postoperative neurological deficits in the management of these schwannomas. Materials and methodsA retrospective study was conducted on 92 cases of peripheral nerve microsurgery performed, using the INM technique. We also made the classification for peripheral nerve schwannomas into two types according to operative findings and proceeded corresponding surgical strategies. ResultsAll tumors were removed completely under microscopy and INM. Three patients developed residual neurological deficits at final follow-up. There were different results about temporary (18/92, 19.6%) and permanent (3/92, 3.3%) neurological deficits. The incidence of temporary and permanent neurological deficits in type II group was significantly higher than that in type I group (p < 0.01). The incidence of permanent neurological deficits in larger size tumors was significantly higher than that of smaller size (p < 0.01). ConclusionsWe made the classification for peripheral nerve schwannomas according to operative findings based on INM that is helpful to our surgical strategies. Intracapsular enucleation was the preferred strategy with satisfactory results and low risk of nerve injury. The size and location of tumors seem to be related to the risk of fascicular injury.

Intraparotid facial nerve schwannoma: a 17-year, single-institution experience of diagnosis and management

Background: Intraparotid facial nerve schwannoma (IFNS) is rare and its definite preoperative diagnosis is challenging.Objective: To improve available knowledge regarding the diagnosis of IFNS and to suggest an appropriate treatment plan.Material and methods: We retrospectively analyzed medical records of IFNS patients at our hospital. Inclusion criteria were surgery (from January 2000, to December 2016) for a parotid mass, pathologically diagnosed as a schwannoma.Results: The study included 42 eligible patients who had undergone tumor resection from 5977 parotid tumor patients. Mostly presented hard-textured (18/39) or medium-textured (15/39), with limited mobility (21/39) mass (three tumors were not palpable). Their facial nerve function outcomes were House–Brackmann Grade I (n = 14), Grade II (n = 7), Grade III (n = 11), Grade IV (n = 5), Grade V (n = 3), and Grade VI (n = 2). Significant differences were noted in results based on different surgical methods used (p = .000) and tumor involvement (p = .002).Conclusions and significance: A hard-textured tumor with limited mobility mass in the parotid gland should prompt the diagnosis of a schwannoma. Tumors involving main trunk usually lead to unsatisfactory facial nerve outcomes. Facial nerve preservation should always be essential, and stripping surgery or intracapsular enucleation could be the preferred surgical methods of choice.

Clinical diagnosis and treatment outcomes for parapharyngeal space schwannomas: A single-institution review of 21 cases.

Because the incidence of schwannoma arising from the parapharyngeal space (PPS) is very low, no studies have analyzed extirpation methods and postoperative neurological complications exclusively in PPS schwannomas. The preoperative diagnosis and clinical outcomes of surgical treatment in 21 patients with PPS schwannoma who underwent surgery were investigated. Neurological deficit of the involved nerve developed in all patients regardless of the extirpation method used. However, the incidence of first bite syndrome in sympathetic chain schwannoma was significantly lower after intracapsular enucleation (40%) than after total resection (100%; P = .045). Furthermore, the incidence of postoperative complications unrelated to the involved nerve was lower after intracapsular enucleation (0%) than after total resection (42.9%; P = .055). Although postoperative neurological deficit of the involved nerve was unavoidable in PPS schwannoma, intracapsular enucleation could be beneficial by reducing its severity and the incidence of complications unrelated to the involved nerve.

Extracranial schwannoma in the carotid space: A retrospective review of 91 cases.

Schwannomas of the vagus nerve and cervical sympathetic nerve are rare; hence, only limited information exists regarding their diagnosis and clinical management. We conducted a retrospective review of the clinical features, imaging studies, and treatment results of patients with schwannoma of the vagus nerve and schwannoma of the sympathetic nerve. Of 91 patients, 91% (n = 83) were preoperatively diagnosed with schwannoma tumors. Using the hyoid bone as an anatomic landmark, the location of the schwannoma of the vagus nerve in the carotid space was significantly different to the location of schwannoma of the sympathetic nerve (p = .003). Although 52 of the 76 patients followed up (68%) had postoperative nerve weaknesses, 13 patients (50%) and 14 patients (53.8%), respectively, fully recovered from schwannoma of the vagus nerve and schwannoma of the sympathetic nerve. In the carotid space, schwannomas of the vagus nerve are usually located below the hyoid bone, whereas schwannomas of the sympathetic nerve more commonly arise from the suprahyoid compartment. Accurate preoperative diagnosis and the intracapsular enucleation surgical approach decreased the incidence of postoperative morbidity. © 2016 Wiley Periodicals, Head Neck 39: 42-47, 2017.

Superiority of resection over enucleation for schwannomas of the cervical vagus nerve: A retrospective cohort study of 22 consecutive patients

IntroductionSchwannoma of the cervical vagus nerve is rare. Treatment options include intracapsular enucleation and en bloc resection. The purpose of this study was to compare the outcomes of enucleation and resection in terms of postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence, quality-adjusted life-year (QALY) and vocal handicap index (VHI). MethodsTwentytwo consecutive patients were divided into two groups. Patients in group A (n = 9) underwent intracapsular enucleation, whereas patients in Group B (n = 13) underwent en bloc resection. Main endpoints of the study were postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence and quality of life. The quality of life after surgery was assessed according to the quality-adjusted life-year (QALY) EQ-5D-5L methodology, and calculation of the voice handicap index (VHI). ResultsPostoperative mortality was nil. Morbidity included 1 wound dehiscence in group A and 2 transitory dysphagias in group B. Freedom from vocal cord palsy was 22% in group A and zero in group B (p = 0.15). Operation-specific local recurrence rate was 33% (3/9 patients) in group A and nil in group B (0/23 patients) (p = 0.05). QALYs was 0.55 in group A and 0.54 in group B (p = 1.0). VHI was 23.77 in group A and 26.15 in group B (p = 1.00). ConclusionResection is superior to enucleation in terms of freedom from local recurrence. Functional results are comparable for both techniques.

Successful enucleation of large multinodular/plexiform schwannoma of the foot and ankle.

BackgroundIt is often challenging to completely resect multinodular/plexiform schwannomas involving important deep nerves using minimally invasive surgically techniques.Case descriptionA 32-year-old woman presented with a 5-year history of a slowly growing, painful mass in the medial aspect of the right ankle. Magnetic resonance imaging (MRI) demonstrated multiple nodular lesions with iso-signal intensity relative to skeletal muscle on T1-weighted sequences and heterogeneous high signal intensity on T2-weighted sequences. Mild to moderate enhancement was identified after gadolinium administration. All 58 tumors were completely enucleated using an intracapsular technique. Histological examination confirmed the diagnosis of schwannoma consisting mainly of Antoni A areas. The burning sensation was relieved immediately after surgery. The patient had no aggravated neurological deficit and was very satisfied with the outcome of the treatment at final follow-up.Discussion and evaluationWe experienced a very rare case of a large multinodular/plexiform schwannoma arising from the posterior tibial nerve and its larger terminal branch. Our case had the characteristic MRI features of this condition. It is extremely important to differentiate multinodular/plexiform schwannoma from plexiform neurofibroma and malignant peripheral nerve sheath tumor, with complete surgical enucleation being curative.ConclusionsMRI is a clinically useful modality in the evaluation and detection of deep-seated multinodular/plexiform schwannoma. Intracapsular enucleation seems to be an acceptable treatment for this peculiar tumor located in the foot and ankle.

Function-sparing intracapsular enucleation of cervical schwannomas.

We review our series of cervical schwannomas to evaluate the safety and efficacy of intracapsular enucleation for function-sparing tumor resection. There were 43 tumors in total, including vagal (n = 20), sympathetic (n = 13), brachial plexus (n = 6), cervical plexus (n = 2), and two with no major neural involvement. Of the 16 vagal tumors that underwent enucleation, 15 had near-normal or normal voices at 1 year. Eight had normal vocal cord function, three had a partially mobile vocal cord with normal voice, and four had an immobile vocal cord with near-normal or normal voices. One patient had an immobile vocal cord requiring medialization laryngoplasty and arytenoid adduction. Of the 13 sympathetic schwannomas, three underwent enucleation. All three of these patients displayed Horner's triad in the early postoperative period; however, each of them significantly improved within the first 6 months. Of the patients with brachial plexus schwannomas, four underwent enucleation with no postoperative deficits in motor function to the arm. Intracapsular enucleation of cervical schwannomas appears to be an effective long-term oncologic treatment while providing significant improvement in functional outcomes.

An algorithm for treating extracranial head and neck schwannomas

Surgical resection of extracranial head and neck schwannomas (ECHNS) may be associated with major morbidity, but some ECHNSs can be safely treated expectantly. The aim of this study is to present a large case series and an algorithm for therapeutic decision-making in the management of ECHNS. The clinical records of patients diagnosed and treated for ECHNS between 1999 and 2012 at The Tel Aviv Sourasky Medical Center were reviewed retrospectively. All relevant demographic and medical data were extracted, among them presenting symptoms, surgical approaches, nerve of origin, complications and follow-up. A total of 53 patients with ECHNS were included in this clinical study. There were 29 males and 24 females whose mean age was 49.2 years, and all were treated surgically. The schwannomas originated from the brachial plexus, sympathetic chain, vagus nerve, trigeminal nerve, lip, hypoglossal nerve and larynx. Intracapsular enucleation was performed in 32 (60 %) patients, and the remaining 21 (40 %) patients underwent complete excision of the tumor with the involved nerve segment. Thirty-two patients (60 %) had postoperative neurological deficits. This study provides an algorithm to serve as a guideline in the decision-making process for this patient population. Although there is abundant evidence regarding the efficacy of radiotherapy for acoustic schwannoma, the value of radiotherapy as a treatment alternative for patients with ECNHS, especially those unsuitable for surgery, has not been established and further studies are warranted.

Editorial to: “Transoral resection of large parapharyngeal space tumors” by Hussain et al.

The parapharyngeal space is not easily accessible for routine clinical examinations and remains silent until affected by pathological processes like tumors [3]. Parapharyngeal space tumors are rare, most are benign. Next to typical salivary gland tumors, the parapharyngeal space can house a variety of even rarer tumors [4]. Imaging studies are essential to get more information on the location (preor post-styloid space) and the extent [6]. In general, magnetic resonance imaging (MRI) with gadolinium is the preferred imaging study for parapharyngeal space neoplasms. In addition, fine-needle aspiration cytology can be useful [10]. In contrast, open biopsy can be hazardous because of the risk of injury to large vessels and cranial nerves in the parapharyngeal space. In case of a pleomorphic adenoma, a preceding biopsy could create adhesions between the tumor and the surrounding tissue making it problematic to remove the neoplasm via blunt dissection what is particularly important for pleomorphic adenoma [4]. Furthermore, a biopsy would per se increase the risk of tumor recurrence. A comprehensive diagnostic work-up is very important because many tumors are benign and slowly growing, often asymptomatic, i.e. there is often no urgency of treatment [4]. The colleagues from the Department of OtolaryngologyHead and Neck surgery in Aberdeen, Scotland, present a case report of their experience with transoral resection of five parapharyngeal space tumors. Due to the small sample size, all conclusions drawn by the author can only regarded as preliminary. Furthermore, the follow-up of the patients with a pleomorphic adenoma is too short to draw any conclusion concerning the risk of tumor recurrence. One patient did not receive any preoperative imaging but a preoperative biopsy. Three patients received preoperative fine-needle aspiration cytology and an MRI examination. And the last patients received a computed tomography (CT) scan preoperatively but no other specific preoperative diagnostics. The aim of the presented prospective investigation was to evaluate a surgical technique. Therefore, from a methodological perspective, it would have been advantageous to use a standardized and established preoperative work-up. Unfortunately, this was not done. The result was that in two patients (cases 1 and 5) a preoperative biopsy was taken although these patients could have had (but fortunately did not as revealed by final histology) a pleomorphic adenoma or, for instance, a sarcoma. In both situations, a biopsy would have been hazardous or even contraindicated! The transcervical approach and the transcervical-parotid approach are the most commonly used surgical approach to the parapharyngeal space [4, 9]. Probably, it would have been possible to resect all five cases using one of the standard approaches. It is very important to emphasize that a transoral removal, i.e. the approach used in the presented study, is associated with an unacceptably high rate of tumor rupture and recurrence for pleomorphic adenomas of the parapharyngeal space managed by transoral removal [1, 2, 4, 5, 8]. Moreover, it is difficult to follow the terminology used by Hussain et al. to describe their transoral approach: the authors describe the technique with the term ‘‘extracapsular dissection’’ although some tumors were resected with piecemeal technique or cored out with an ultrasonic aspirator or with a microdebrider. De facto, a piecemeal technique or coring out a tumor should be named ‘‘intracapsular enucleation’’ [11] and some of the O. Guntinas-Lichius (&) Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany e-mail: Orlando.Guntinas@med.uni-jena.de

Diagnosis and Management of Extracranial Head and Neck Schwannomas: A Review of 27 Cases

Objectives. Clinical records of 27 patients with extracranial head and neck schwannoma were retrospectively reviewed. Methods. Ultrasonography (US) was performed in all cases. Seven patients underwent CT. Twenty-five patients underwent MRI. Fine needle aspiration cytology (FNAC) was performed for 12 of the 27 patients. Clinical history, surgical data, and postoperative morbidity were analyzed. Results. The images of US showed a well-defined, hypoechoic, primarily homogeneous solid mass. At CT, only one of 7 cases (14%) was able to suggest the diagnosis of schwannoma. At MRI, twenty of 25 cases (80%) suggested the diagnosis of schwannoma. Only three of 12 cases (25%) displayed a specific diagnosis of schwannoma rendered on FNAC. The distribution of 27 nerves of origin was 10 (37%) vagus nerves, 6 (22%) sympathetic trunks, 5 (19%) cervical plexuses, 3 (11%) brachial plexuses, 2 (7%) hypoglossal nerves, and 1 (4%) accessory nerve. Complete tumor resection was performed in 11 patients, and intracapsular enucleation of the tumor was performed in 16 patients. The rate of nerve palsy was 100 (11/11) and 31% (5/16). Conclusions. MRI is sensitive and specific in the diagnosis of schwannoma. Intracapsular enucleation was an effective and feasible method for preserving the neurological functions.

Experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumours: a retrospective analysis of 58 patients

The objective of this study was to review the experience of video-assisted thoracoscopic resection of posterior mediastinal neurogenic tumours and to investigate the technical features and difficulties of this thoracoscopic approach. From May 2001 to June 2011, 58 consecutive patients underwent thoracoscopic resection of posterior mediastinal tumours sequentially in our institution, including 36 males and 22 females. The median age of the patients was 38.7 years. The median tumour size was 4.9 cm. Twenty-four lesions were located at the left side, 33 lesions at the right side and 1 lesion at the bilateral side. All procedures generally required three ports, and intracapsular enucleation was preferred. For bulky tumours, dense adhesion and massive bleeding, conversion to thoracotomy was performed by extending the anterior incision to 6-10 cm. All procedures were successfully performed without death or serious complications occurring. The average operating duration was 127.2 min. The average intraoperative blood loss was 206.4 mL. The average chest tube drainage duration was 2.72 days. The average post-operative stay was 5.19 days. Fifty-three procedures were performed entirely under thoracoscopy to achieve gross total resection. There were five cases (8.6%) of conversion to thoracotomy procedure. Seven patients suffered from post-operative complications, including four Horner syndromes. No local recurrence occurred after an average follow-up of 44.9 months. Video-assisted thoracoscopic resections of the posterior mediastinal tumours were safe and reliable for selected patients with mastered thoracoscopic skills. Intracapsular enucleation was demonstrated to be a safe procedure. For tumours larger than 6 cm and located in the apex, the risk of the operation increased significantly.