Videothoracoscopic Resection of Benign Neurogenic Tumors of the Posterior Mediastinum

Abstract

Objective

Videothoracoscopy is becoming the preferred approach for the removal of neurogenic mediastinal tumors. Tumors extending into the spinal canal (dumbbell type) require a combined neurosurgical approach. The aim of the study was to evaluate the feasibility of videothoracoscopic resection of benign neurogenic tumors (BNT) of the posterior mediastinum, including dumbbell-type tumors, through a retrospective review of our experience.

Methods

Between January 1993 and November 2005, 30 patients underwent resection of a BNT of the posterior mediastinum at our institution. Twenty-five tumors developed in the costovertebral sulcus, and five were dumbbell type. Preoperative assessment included chest CT scan, nuclear magnetic resonance for dumbbell-type tumors, and spinal angiography when the tumor was located in the vicinity of the Adamkiewicz artery.

Results

Mean tumor size was 5.6 ±1.4 cm (range, 4 to 11). Videothoracoscopic resection was possible in 26 patients, 5 of whom had dumbbell-type tumors requiring a combined neurosurgical approach. Reasons for conversion to thoracotomy were pleural adhesions in one case and bleeding in three. Mean operative time was 215 ± 42 minutes (range, 180 to 280) for the patients with dumbbell-type tumors and 140 ± 55 minutes (range, 95 to 230) for those without. There were no operative and/or postoperative complications. Histology showed 25 schwannomas, 4 ganglioneuromas, and 1 neurofibroma. Mean postoperative stay was longer for the patients with dumbbell-type tumors (6.5 ± 1 versus 4 ± 1 day).

Conclusions

BNT of the posterior mediastinum, including dumbbell-type tumors, can be safely resected thoracoscopically. The feasibility of a videothoracoscopic approach should be assessed on the basis of the preoperative evaluation. Pleural adhesions and bleeding may determine conversion to thoracotomy.