Posterior Mediastinal Neurogenic Tumors Research Articles

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.

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.

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.

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.

Mediastinal Hydatid Cyst Mimicking Malignant Mediastinal Neurogenic Tumor

Hydatid disease is caused by Echinococcus granulosus parasite. It is an endemic disease; particularly in many Mediterranean countries. The liver and the lungs are most frequently involved. Bone involvement is reported in 1% - 2% of the cases and about 50% of those are seen in the spine. Herein we report a case of primary spinal extradural hydatid cyst that caused paraplegia due to compression of the dorsal spinal cord and was diagnosed initially as case of lumber prolapsed intervertebral disc. The cyst was only discovered when the patient had progressive paraplegia and the preoperative provisional diagnosis was posterior mediastinal neurogenic tumor causing destruction of the pedicle and lamina of the fifth thoracic vertebra. Fortunately, she regained near full power after surgical treatment of her spinal cyst.

Thorascopic Resection of An Apical Paraspinal Schwannoma Using the da Vinci Surgical System

Posterior mediastinal neurogenic tumors have traditionally been resected via an open posterolateral thoracotomy. Video-assisted thorascopic surgery has emerged as an alternative technique allowing for improved morbidity with decreased blood loss, less postoperative pain, and a shorter recovery period, among others. The da Vinci surgical system, as first described for urologic procedures, has recently been reported for lung lobectomy. This technique provides the advantages of instrumentation with 6 degrees of freedom, stable operating arms, and improved visualization with the three-dimensional high-definition camera. We describe the technique for thorascopic resection of an apical paraspinal schwannoma of the T1 nerve root with the da Vinci surgical system. This technique used a specialized intraoperative neuromonitoring probe for free-running electromyography (EMG) and triggered EMG. We demonstrate successful resection of a posterior paraspinal schwannoma with the da Vinci surgical system while preserving neurologic function. The patient displayed stable intraoperative monitoring of the T1 nerve root and full intrinsic hand strength postoperatively. The technique described in this article introduces robotic system accuracy and precludes the need for an open thoracotomy. In addition, this approach demonstrates the ability of the da Vinci surgical system to safely dissect tumors from their neural attachments and is applicable to other such lesions of similar size and location.

Extramedullary Hematopoiesis at the Posterior Mediastinum in Patient with Hereditary Spherocytosis: A Case Report

Thoracic extramedullary hematopoiesis (EMH) is a rare disease entity that is usually associated with hematologic disorders, such as myelodysplastic or hemolytic disease. Because thoracic EMH is usually encountered as a mass during radiologic examinations, it should be differentiated from posterior mediastinal neurogenic tumors. Here, the authors report a case of EMH associated with hereditary spherocytosis. The patient underwent a complete excision by thoracoscopic surgery to differentiate it from other mediastinal tumors.

Preferred surgical procedure for posterior mediastinal neurogenic tumor.

To compare the outcomes of video-assisted thoracoscopic surgery (VATS) with those of thoracotomy for the removal of posterior mediastinal neurogenic tumors. Twenty-four patients were enrolled in the VATS group and 29 were enrolled in thoracotomy group between 1996 and 2010. When compared with the thoracotomy group, patients in the VATS group had a shorter operation time (90 ± 29 min vs. 136 ± 41 min, P < 0.001), less blood loss (42 ± 12 mL vs. 209 ± 162 mL, P < 0.001), shorter time to extubation and discharge (2.5 ± 0.7 days vs. 3.1 ± 1.0 days, P= 0.027; 3.6 ± 0.6 days vs. 4.1 ± 1.0 days, P= 0.045). VATS is a safe and effective surgical procedure for posterior mediastinal neurogenic tumors with better outcomes than thoracotomy.

Benign Posterior Mediastinal Neurogenic Tumors: Results of a Comparative Study into Video-Assisted Thoracic Surgery and Thoracotomy (13 Years' Experience)

Mediastinal neurogenic tumors originate from the nerve tissues of the thorax and are generally located in the posterior mediastinum. The present study was performed to compare the results of thoracotomy with those of video-assisted thoracic surgery (VATS) for the surgical treatment of posterior mediastinal neurogenic tumors. Twenty patients who underwent surgical resection for posterior neurogenic tumors between January 1996 and January 2009 were examined retrospectively. Thirteen (65%) patients were treated by thoracotomy (group T) and VATS was used in seven (35%) patients (group V). The duration of surgery was shorter in group V (83.5 ± 19 min) than in group T (124.6 ± 16.6 min; P < 0.0001). Chest drains were withdrawn earlier in group V (after 1 day) than in group T (1.6 ± 0.5 days; P = 0.005). The hospital stay was shorter for group V (1 day) compared with group T (3 ± 0.9 days; P < 0.0001) and group V required fewer analgesics than group T (P < 0.0001). VATS is the preferred treatment for posterior neurogenic tumors that show no preoperative signs of malignancy and do not involve the medulla spinalis.

Double Primary Tumor, Thymic Mass and Posterior Mediastinal Neurogenic Tumor, in a Patient With Acute Pancreatitis Performed With Single-staged Robotic-assisted Thoracoscopic Surgery

Finding 2 primary benign lesions at 2 extremes of the mediastinum is a rare event. A minimal invasive operation performed in a single-staged procedure can prove to be difficult, especially when the procedure is performed with a robot. We discuss the positioning and details of the procedure carried out in a 52-year-old woman with acute pancreatitis.

Technique of Thoracoscopic Resection of Posterior Mediastinal Tumors

Tumors of the posterior mediastinum, located in the paravertebral sulcus, account for about 25% of all mediastinal tumors. They are typically related to the sympathetic chain or the rami of intercostal nerves. Mediastinal neurogenic tumors are among the more frequent mediastinal masses seen in adults. Although they are often malignant in children, over 90% are benign in the adult population. Surgical resection is usually indicated. Posterior mediastinal tumors are frequently nerve-related neoplasms. Neurogenic tumors originate from embryonal neural crest cells, which constitute the ganglia, paraganglionic, and parasympathetic systems. Nerve sheath tumors are the most common posterior, paravertebral tumors, accounting for 40 to 60% of all neurogenic tumors. Approximately 10% have spinal canal involvement (“dumbbell” or “hourglass” tumors), thus impacting the approach to resection. Nerve sheath tumors commonly originate from Schwann cells of intercostal nerves. Although almost always benign, malignant degeneration may rarely occur. Neurofibromas also arise from peripheral nerves, with 30 to 40% of neurofibromas occurring in the setting of neurofibromatosis. Multiple tumors may occur in these individuals. The patients with von Recklinghausen’s disease frequently present at a younger age and have a higher risk of malignancy. Ganglioneuromas and ganglioneuroblastomas arise from sympathetic ganglion nerve cells. Although ganglioneuromas are benign, they tend to adhere to adjacent structures, making resection more challenging than with schwannomas. This is the most frequent benign neurogenic tumor in children. In contradistinction to ganglioneuromas, neuroblastomas frequently metastasize. Most posterior mediastinal neurogenic tumors are benign, slow growing, and asymptomatic. They may be present for a long period of time before diagnosis. However, with growth, they can produce symptoms by local compression of adjacent tissue, bone erosion, and spinal canal involvement. Large intrathoracic tumors may produce dyspnea, pain, and cough. Neurologic deficits may also occur. Spinal cord compression from dumbbell tumors may cause abnormal gait, urinary and fecal incontinence, and loss of sensation below the lesion. Radicular pain at the level of the tumor may present with a dermatomal distribution. Occasionally a high thoracic tumor may result in Horner’s syndrome. Currently, most posterior mediastinal tumors are identified incidentally, often on plain chest radiography obtained for other, unrelated indications. Chest computed tomography is indicated to effectively demonstrate size, location, and relationship to adjacent structures. Tumors of nerve sheath origin are typically smooth, spherical, solitary, and discrete. They usually abut vertebral bodies. In the setting of neurofibromatosis, they may be multifocal and appear lobulated. In contrast, tumors of autonomic ganglion (nerve cell) origin may be less circumscribed and often are oblong. Bony changes related to pressure or erosion may be present. Occasionally magnetic resonance imaging (MRI) may be useful for evaluating proximity to the neural foramen (Fig. 1) and for determining spinal cord involvement with dumbbell tumors. Percutaneous biopsy is not required for most posterior mediastinal neurogenic tumors because radiographic diagnosis is sufficient to mandate resection. Observation of posterior mediastinal tumors is rarely appropriate, unless the patient is at prohibitively high risk for thoracoscopic surgery due to significant medical comorbidities. Surgical resection simultaneously provides both diagnosis and therapy. Moreover, permitting growth may result in expansion of the tumor into the neural foramen, requiring a more complex multistage operation involving both posterior and anterior approaches.

Thoracoscopic resection as the preferred approach to posterior mediastinal neurogenic tumors.

Traditionally, resection of posterior mediastinal neurogenic tumors (PMNTs) has been through a posterolateral thoracotomy. Although thoracoscopic resection of these tumors has been advocated, treatment guidelines have not been reported previously. The authors report a thoracoscopic resection of a PMNT and conducted a retrospective review of similar cases in the literature. Successful thoracoscopic resection was compared with tumor size and type using a nonpaired t test (alpha: P < 0.05). A total of 29 patients (13 men, 16 women), aged 26 to 68 years, who underwent a thoracoscopic resection of a PMNT were identified. Preoperative imaging included chest radiography and computed tomography in all patients and magnetic resonance imaging in 15 of 29 patients (52%). All tumors were located in the posterior mediastinum without preoperative evidence of invasion or malignancy. Conversion to an open procedure was necessitated in 12 of 29 (41%) patients ("minithoracotomy" in 11, posterolateral thoracotomy in 1). Tumor size necessitating conversion to an open procedure (mean = 4.79 cm) and tumor size amenable to thoracoscopy alone (mean = 3.84 cm) were not significantly different (P < 0.09). Pathology revealed 22 schwannomas (76%), 6 ganglioneuromas (21%), and 1 malignant schwannoma (3%) and was not associated with conversion to an open procedure (P < 0.99). Thoracoscopic resection of PMNTs can be performed successfully, regardless of tumor type or size; however, malignancy, local invasion, and tumors >5 cm may require an open procedure. Thoracoscopic resection can replace thoracotomy in the treatment of PMNTs.

Thoracoscopic Resection as the Preferred Approach to Posterior Mediastinal Neurogenic Tumors

Traditionally, resection of posterior mediastinal neurogenic tumors (PMNTs) has been through a posterolateral thoracotomy. Although thoracoscopic resection of these tumors has been advocated, treatment guidelines have not been reported previously. The authors report a thoracoscopic resection of a PMNT and conducted a retrospective review of similar cases in the literature. Successful thoracoscopic resection was compared with tumor size and type using a nonpaired t test (α:P < 0.05). A total of 29 patients (13 men, 16 women), aged 26 to 68 years, who underwent a thoracoscopic resection of a PMNT were identified. Preoperative imaging included chest radiography and computed tomography in all patients and magnetic resonance imaging in 15 of 29 patients (52%). All tumors were located in the posterior mediastinum without preoperative evidence of invasion or malignancy. Conversion to an open procedure was necessitated in 12 of 29 (41%) patients (“minithoracotomy” in 11, posterolateral thoracotomy in 1). Tumor size necessitating conversion to an open procedure (mean = 4.79 cm) and tumor size amenable to thoracoscopy alone (mean = 3.84 cm) were not significantly different (P < 0.09). Pathology revealed 22 schwannomas (76%), 6 ganglioneuromas (21%), and 1 malignant schwannoma (3%) and was not associated with conversion to an open procedure (P < 0.99). Thoracoscopic resection of PMNTs can be performed successfully, regardless of tumor type or size; however, malignancy, local invasion, and tumors >5 cm may require an open procedure. Thoracoscopic resection can replace thoracotomy in the treatment of PMNTs.

Posterior mediastinal neurogenic tumors in infants and children.

Posterior mediastinal neurogenic tumors in infants and children.