Mediastinal Neurogenic Tumors Research Articles

Robotic excision of posterior mediastinal neurogenic tumours: Technique and surgical outcomes.

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. 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. 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. Our study demonstrates the feasibility and safety of robotic surgery for posterior mediastinal neurogenic tumours with good surgical outcomes.

Resection of a schwannoma originating from vagus nerve in the right superior mediastinum

BackgroundSchwannoma is the most common mediastinal neurogenic tumor, while schwannoma originating from mediastinal vagus nerve is rare.Case presentationThis article reported one case of schwannoma originating from vagus nerve in the right superior mediastinum. The mediastinal schwannoma was completely resected through a right-sided video-assisted thoracoscopic thoracotomy. Histologic examination clarified the diagnosis as schwannoma.ConclusionChest CT scan and MRI can be used to determine the location of mediastinal schwannoma and its relationship with adjacent tissue. Histologic examination showing distinctive feature of Antoni A areas and Antoni B areas can help clarify the diagnosis. Complete surgical resection is the first-line treatment option for mediastinal schwannomas.

Analysis of the efficacy of the da Vinci robot in surgery for posterior mediastinal neurogenic tumors

BackgroundThe present research is designed to evaluate the short-term outcome of robot-assisted thoracoscopic surgery (RATS) for the treatment of posterior mediastinal neurogenic tumors.MethodsWe retrospectively analyzed clinical data on 39 consecutive patients with mediastinal neurogenic tumors after RATS treatment completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from January 2016 to September 2022. There were 22 males and 17 females with a mean age of (35.1 ± 6.9) years in this analysis report. The tumors of the patients were localized and evaluated preoperatively using magnetic resonance imaging (MRI) or enhanced CT.ResultsAll 39 patients successfully underwent the resection of posterior mediastinal neurogenic tumors under RATS, and no conversion to thoracotomy occurred during the operations. The average operative time was (62.1 ± 17.2) min, the average docking time was (10.1 ± 2.5) min, the average intraoperative bleeding was (32.8 ± 19.5) ml, the average 24-h postoperative chest drainage was (67.4 ± 27.9) ml, the average postoperative chest drainage time was (2.2 ± 1.3) days and the average post-operative hospital stay was (3.2 ± 1.3) days. Postoperative complications occurred in 3 patients, including 2 patients with transient Horner's syndrome after surgery and 1 patient with transient anhidrosis of the affected upper limb after surgery.ConclusionRATS for posterior mediastinal neurogenic tumors is safe, effective, feasible and bring the superiority of robotic surgical system into full play.

A single-center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors.

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. A single-center retrospective analysis of 37 patients with pediatric mediastinal neurogenic tumors was conducted. Clinical charactersistics and postoperative complications were all analyzed. 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). 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.

Müllerian Cyst in the Posterior Mediastinum: A Case Report and Review of Literature

A Müllerian cyst is a rare newly identified cyst of the posterior mediastinum. It is an important differential diagnosis to other more commonly known mediastinal neurogenic tumor or bronchogenic cyst. This current report represents a case of 51-year-old woman with an incidentally identified mediastinal Müllerian cyst with review of literature.

Ancient Schwannoma of Vagus Nerve Mimicking Hamartoma

Schwannomas arising from vagus nerve sheath are rare mediastinal neurogenic tumours. Schwannomas usually arise from left hemithorax. Unlike a hamartoma, radiologically, calcification is rarely seen in schwannomas. We present the rare case of an ancient schwannoma arising from vagus nerve sheath from the right hemithorax presenting with gross calcification.

Müllerian Cyst in the Posterior Mediastinum: A Case Report and review of literature

A Müllerian cyst is a rare, newly identified cyst of the posterior mediastinum. It is an important differential diagnosis to other more commonly known mediastinal neurogenic tumours or bronchogenic cysts. This current report represents a case of a 51-year-old woman with an incidentally identified mediastinal Müllerian cyst with a literature review.

Thoracoscopic management of posterior mediastinal neurogenic tumours.

Background:This study describes the surgical technique of thoracoscopic resection of posterior mediastinal neurogenic tumours and reporting the surgical outcomes.Methods:This is a retrospective analysis of 21 patients operated over 7 years in a dedicated thoracic surgery centre. The demographic and post-operative parameters along with complications were recorded and analysed.Results:Twelve patients had right-sided tumours, while 9 had left-sided lesions, and 9 were on the left side. The most common diagnosis was schwannoma (n = 15, 71.42%), followed by neurofibroma (n = 4, 19.04%). The average surgery duration was 104 min (85–135 min), and the mean blood loss was 120 ml (25 ml–250 ml). The average lesion size was 4.8 cm (2 cm–7 cm). Conversion to open procedure was required in one patient. Two patients (14.2%) developed complications. One patient developed Horner's Syndrome and the other developed post-operative lung atelectasis. The median follow-up was 36 months (6–90 months). No recurrence was observed during the follow-up period.Conclusions:Thoracoscopic approach to posterior mediastinal neurogenic tumours is feasible and allows for low morbidity, short hospital stay and superior cosmesis.

Comparison of VATS and Thoracotomy Results in Mediastinal Neurogenic Tumors.

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. 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. 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). 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.

Surgery for mediastinal neurogenic tumours: a 25-year single-centre retrospective study.

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. 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. 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). 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.

Outcomes of minimally invasive surgery for mediastinal neurogenic tumors

To improve postoperative outcomes in patients with mediastinal neurogenic tumors by using of minimally invasive surgical approaches. A retrospective analysis included 108 patients who underwent surgery for mediastinal neurogenic tumors for the period 2001-2019. Short-term outcomes of conventional and minimally invasive (VATS, supraclavicular approach and their combination with laminectomy) surgeries were analyzed. Paravertebral tumor in posterior mediastinum was diagnosed in 71 patients, apical neoplasm - 34 patients, anterior mediastinal tumor - in 3 patients. Thirteen patients had dumbbell tumors. VATS was applied in 61 (56.5%) patients, thoracotomy - 22 (20.4%) cases, supraclavicular approach - 4 (3.7%) patients, combination of VATS and supraclavicular approach - 2 (1.9%) patients, cervicosternotomy - 10 (9.3%) cases, combination of VATS and laminectomy - 2 (1.9%) patients, thoracotomy and laminectomy - 3 (2.8%) cases, supraclavicular approach and laminectomy - 1 (0.9%) patient, cervicosternotomy and laminectomy - 3 (2.8%) patients. Regardless location of tumor, minimally invasive surgery reduced blood loss, perioperative morbidity, duration of drainage and hospital-stay. Most posterior neurogenic tumors can be resected via VATS. Supraclavicular approach is recommended for tumors extending in cervical region. Combination of laminectomy and VATS or supraclavicular approach are appropriate for patients with dumbbell tumors.

Результаты хирургического лечения медиастинальных нейрогенных опухолей типа "гантели"

Результаты хирургического лечения медиастинальных нейрогенных опухолей типа "гантели"

Clinical features and outcomes of surgical treatment of malignant mediastinal neurogenic tumors

Clinical features and outcomes of surgical treatment of malignant mediastinal neurogenic tumors

Clinical efficacy of robot-assisted thoracoscopic surgery for posterior mediastinal neurogenic tumors.

BackgroundRobot-assisted thoracic surgery (RATS) has an increasing usage throughout the world. This retrospective cohort study aimed to objectively compare the surgical results between video-assisted thoracic surgery (VATS) and RATS in posterior mediastinal neurogenic tumors (PMNT).MethodsWe retrospectively reviewed the clinical data of 130 patients diagnosed with posterior mediastinal neurogenic tumor between 2015 and 2018. Magnetic resonance imaging (MRI) or enhanced computed tomography scan (CT-scan) was used to locate the tumor and investigate the Adamkiewicz’s artery preoperatively. The individual surgical approach was determined by both tumor size and patient’s willings.ResultsThe surgical time in RATS (43.2±12.6 min) was tended to be less than that in VATS (47.4±11.9 min) (P=0.054). Meanwhile, the estimated blood loss in RATS group (85.8±22.6 mL) was significantly less than that in VATS group (95.3±28.4 mL) (P=0.040). However, the duration of chest tube (days) and volume of drainage (mL) had no significant difference between two groups (P=0.12 and P=0.68, respectively). The postoperative hospital stay (days) of patients in RATS group (2.2±0.4 days) was significantly shorter than that in VATS group (2.4±0.6 days) (P=0.031). There were no significant differences between two groups in the incidence of the postoperative complications and adverse reactions.ConclusionsRATS has the superiorities in terms of surgical blood loss and postoperative hospital stay over VATS for posterior mediastinal neurogenic tumor. In conclusion, RATS could be a feasible and safe way for resecting posterior mediastinal neurogenic tumor.

Surgical treatment of benign mediastinal neurogenic tumors – a 7-year analysis

Surgical treatment of benign mediastinal neurogenic tumors – a 7-year analysis

Giant posterior mediastinal schwannoma with ancient features

Schwannomas are the most common posterior mediastinal neurogenic tumors. They typically grow insidiously and are often incidentally found in older adults on imaging performed for other reasons. The size of these lesions is usually less than 10 cm and they are often asymptomatic. However, here we describe the case of a young adult with a symptomatic 11×13 cm posterior mediastinal schwannoma with focal ancient features. Briefly, a 23-year-old non-smoking female with a past medical history of scoliosis presented to her primary care provider with complaints of 2 years of intermittent cough and vague chest heaviness that was worse when lying on her right side. She denied any shortness of breath, difficulty breathing, or chest pain. A chest-X-ray showed a large apical mass in the right hemithorax and computed tomography (CT) imaging revealed a large posterior apical mass with midline shift of the upper mediastinal contents and resultant tracheal narrowing. She underwent additional imaging and then a right thoracotomy with excision of an 11×13 cm apical mass. Pathology revealed a schwannoma with focal ancient features and expression of S100. Her post-operative course was relatively unremarkable, except that she did develop contralateral compensatory flushing and hyperhidrosis with exercise. This is indicative of division of the ipsilateral sympathetic chain during excision. Given the size of the mass and pathologic findings she had a repeat CT scan 6 and 24 months post-operatively to demonstrate absence of recurrence.

Benign posterior mediastinal schwannoma-Multiple diagnostic imaging modalities.

Schwannoma is usually benign, encapsulated spindle cell tumor which arises from schwann cells of nerve sheath, and is the most common of the neurogenic mediastinal tumors. Various imaging modalities can be applied to assess posterior mediastinal mass which is often found incidentally without symptom and frequently misdiagnosed for other benign conditions both clinically and radiologically in which clinicians should be aware of.

Spinal canal invasion incidence and surgical approach to the neurogenic tumors of the posterior mediastinum

Amaç: Posterior mediastinal nörojenik tümörlerin yaklaşık %10’u spinal kanala invazedir. İnvaze tümörlerin tek seansta güvenli bir şekilde spinal ve torasik komponentinin birlikte çıkarılması gerekir. Bu lokalizasyondaki tümörlerin spinal kanal invazyonunun olup olmadığının direkt ve indirekt bulguları, ameliyat öncesi çektirilen bilgisayarlı tomografi (BT) ve manyetik rezonans görüntülemesi (MRI) ile detaylı olarak değerlendirilmelidir. Çalışmamızda, kliniğimizde opere ettiğimiz bu tür tümörlerdeki tanı ve yaklaşımımızın sunulması amaçlanmıştır.Gereç ve Yöntem: Nörojenik tümör nedeni ile opere ettiğimiz tüm hastaların klinik bilgileri retrospektif olarak analiz edildi. Bulgular: Çalışmaya aldığımız 35 hastanın 19’u erkek 16’sı kadındı ve yaş ortalaması 40 yıldı (dağılım: 19-71). Hastaların sadece 5’inde (%14) operasyon öncesi semptom mevcuttu. Tümör boyutları 2,1 cm ile 17 cm arasında (ortanca 6,2) idi. Hastaların 7’sinde (%20) radyolojik olarak spinal kanal invazyonu olduğu belirtildi. Laminektomi gerektiren dumbbell tipteki 6 hasta ile birlikte hepsi komplet olarak rezeke edildi. İnvazyon gösteren vakalardaki lezyonlar beyin ve sinir cerrahi uzmanı ile birlikte yapıldı. Ortalama takip süresi 48 ay (3 ila 72 ay) idi. Bir hastada ameliyat sırasında tamir edilen serebrospinal sıvı kaçağı ile postoperatif kalıcı olmayan spinal hasar meydana geldi ve 4 ayda düzeldi. Mortalite gözlenmedi. Sonuç: Ameliyat öncesinde, nörojenik dumbbell tümör teşhis edilmezse, sadece intratorasik kısmının çıkarılması, kalıcı spinal hasara neden olabilir. Spinal kanalı incelemek için MRI kritik öneme sahiptir. Preoperatif invazyon tespit edildiğinde tek seansta sinir cerrahisi ekibi ile birlikte tümörün daha güvenli rezeksiyonu mümkündür.

Surgical treatment of posterior mediastinal neurogenic tumors.

Posterior mediastinal neurogenic tumors are among the most frequent mediastinal masses in adults. These tumors may be dumbbell shaped, extending into the spinal canal, exclusively paraspinal or apical tumors extending in the cervical region. In this report, we present our experience in the surgical resection of these tumors and discuss the surgical strategies for such tumors. A retrospective analysis was performed of 121 patients who underwent surgery for posterior mediastinal neurogenic tumors at our department during the period 2009 to 2016. Seventy-four tumors were excised via video-assisted thoracic surgery (VATS). Other approaches included thoracotomy, supraclavicular incision, supraclavicular incision plus thoracotomy/VATS, and a posterior approach with laminectomy combined with thoracotomy/VATS. Tumors were resected completely in 119 cases and partially in two. The majority of the tumors were benign nerve sheath tumors. No recurrence developed during postoperative median follow-up period of 31 months. Most posterior neurogenic tumors can be resected via VATS. Thoracotomy is the appropriate surgical approach for large tumors. A supraclavicular approach is recommended for tumors extending in the cervical region, and this can be combined with VATS or thoracotomy in case of larger masses. A posterior approach could be used for patients with dumbbell tumors.

Primary mediastinal melanotic schwannian tumors: A clinicopathological and immunohistochemical study of 5 cases

Mediastinal neurogenic tumors are unusual and more so is the presence of melanotic neurogenic tumors. We present five cases of mediastinal melanotic neurogenic tumors. The patients are five men between the ages of 34 and 43 years (average: 38.5 years). All patients presented with non-specific symptoms that included back pain and cough. Diagnostic imaging revealed the presence of a posterior mediastinal mass without connection to the spinal canal, and surgical resection was accomplished in all of the patients. Histologically, the five tumors showed a spindle epithelioid cellular proliferation, nuclear atypia, mitotic activity, and melanin deposition. Histochemical stain for Fontana Masson clearly demonstrated the presence of melanin pigment in all the cases, while S-100 protein was only focally positive in tumor cells. Other immunohistochemical stains including SOX-10, MITF, HMB-45, and Melan A were negative. Clinical follow-up showed that two patients died 22 and 30 months after initial diagnosis; one remains alive, 6 months after initial diagnosis; two patients were lost to follow up. Melanotic neurogenic tumors represent a diagnostic challenge for pigmented thoracic tumors and careful analysis of the morphology and immunohistochemistry is required to lead to proper diagnosis.