Anterior Trans Anterior Trans cervicothoracic approach for cervicothoracic approach for

complete resection of complete resection of cervicothoracic mediastinal cervicothoracic mediastinal

tumorstumors

Dr. R. Bagheri Thoracic surgeon-Assistant professor Of Mashhad University of

Medical Sciences-IRAN

Dr. M. Rajabi General surgeon-Associate professor Of Mashhad University of

Medical Sciences-IRAN

Dr .H. Mashhadi NeJad Neurosurgeon- Associate professor of Mashhad University of Medical

Sciences-IRAN

Dr. R. Bagheri Thoracic surgeon-Assistant professor Of Mashhad University of

Medical Sciences-IRAN

Dr. M. Rajabi General surgeon-Associate professor Of Mashhad University of

Medical Sciences-IRAN

Dr .H. Mashhadi NeJad Neurosurgeon- Associate professor of Mashhad University of Medical

Sciences-IRAN

IntroductionIntroduction

• Mediastinal tumors consist of a wide spectrum of benign and malignant disease. Some of these tumors which locate in the thoracic apex can

produce many problems in decision making due to developing to neck spaces, because with

thoracotomy approach most of these tumors cannot be resected totally due to close attachment of these

tumors with great vessels and removal of these tumors with dangerous complications and massive

hemohrrages during surgery. • The goal of this study is to report the operated cases

of these kinds of tumors with anterior trans cervical-thoracic approach.

• Mediastinal tumors consist of a wide spectrum of benign and malignant disease. Some of these tumors which locate in the thoracic apex can

produce many problems in decision making due to developing to neck spaces, because with

thoracotomy approach most of these tumors cannot be resected totally due to close attachment of these

tumors with great vessels and removal of these tumors with dangerous complications and massive

hemohrrages during surgery. • The goal of this study is to report the operated cases

of these kinds of tumors with anterior trans cervical-thoracic approach.

TechniqueTechnique

• Depending on the tumor development in neck spaces, first with on oblique incision

near the SCM (Sternuclidomastoeid) muscle neck space dissection is done, In all patients

the clavicula head is resected to see the subclavian vessels, Then with continuing the

incision, as in partial stennotomy, the mediastinal space, is being assessed for

complete removal of tumor, If needed, for complete removal of mediastinal tumor, the

operation is completed with an anterior thoracotomy.

• Depending on the tumor development in neck spaces, first with on oblique incision

near the SCM (Sternuclidomastoeid) muscle neck space dissection is done, In all patients

the clavicula head is resected to see the subclavian vessels, Then with continuing the

incision, as in partial stennotomy, the mediastinal space, is being assessed for

complete removal of tumor, If needed, for complete removal of mediastinal tumor, the

operation is completed with an anterior thoracotomy.

TechniqueTechnique

TechniqueTechnique

TechniqueTechnique

TechniqueTechnique

Case Case reportreport

• A 10 years old girl admited to hospital because of exersional dyspena with a neck mass in chest x-ray and CT-scan

• A 10 years old girl admited to hospital because of exersional dyspena with a neck mass in chest x-ray and CT-scan

• Biopsy of neck mass was performed and pathologist reported

Ganglioneuroblastoma and patient underwent surgery by posterolateral

thoracotomy approach but during the surgery subclavian artery was damaged and due to massive

hemorrhage incomplete removed of tumor performed with repair of

subclavian artery

• Biopsy of neck mass was performed and pathologist reported

Ganglioneuroblastoma and patient underwent surgery by posterolateral

thoracotomy approach but during the surgery subclavian artery was damaged and due to massive

hemorrhage incomplete removed of tumor performed with repair of

subclavian artery

• In another stage patient underwent surgery by (ATCTA) and complete resection of tumor was performed

• In another stage patient underwent surgery by (ATCTA) and complete resection of tumor was performed

• A 20 years old man with perevious history of neurofibroma (with typical

skin lesion) admited to hospital became of cervico mediastinal tumors

• A 20 years old man with perevious history of neurofibroma (with typical

skin lesion) admited to hospital became of cervico mediastinal tumors

• Patient underwent surgery by ATCT approach and complete resection of

tumor was performed

• Patient underwent surgery by ATCT approach and complete resection of

tumor was performed

• A 20 years old female admited to hospital because of cervicomediastinal mass biopsy was performed and report

of pathologist was neurofibroma

• A 20 years old female admited to hospital because of cervicomediastinal mass biopsy was performed and report

of pathologist was neurofibroma

• Patient underwent surgery by ATCT approach and complete resection of

tumor was performed (by team working with neurosurgeon) residual of tumor

remained in neck became of involvement of nerve root in neck

• Patient underwent surgery by ATCT approach and complete resection of

tumor was performed (by team working with neurosurgeon) residual of tumor

remained in neck became of involvement of nerve root in neck

ResultResult

• In all three patients tumors were completely removed by mentioned technique and only in

one case an anterior thoracotomy was needed to remove the huge mediastinal

tumor. Total resection of tumors were done in all 3 patients and there were no severe

injuries to great vessels and all patients were discharged from hospital without any

complications and are being observed for 6 months until now without tumor recurring.

The median time for hospitalization was 5.5 days.

• In all three patients tumors were completely removed by mentioned technique and only in

one case an anterior thoracotomy was needed to remove the huge mediastinal

tumor. Total resection of tumors were done in all 3 patients and there were no severe

injuries to great vessels and all patients were discharged from hospital without any

complications and are being observed for 6 months until now without tumor recurring.

The median time for hospitalization was 5.5 days.

DiscussionDiscussion

• First discription: 1963 by steenburg in patient with traumatic rupture of subclavian artery

• With development of these technique surgery of bronchogenic tumors with thoracic inlet involvement was performed (dartevelle P.G)

• Succeed of this technique in surgery of one stage cervicothoracic mediastinal mass removal mentioned by (Macchiarini P, Pranikoff T, Korst RJ, Coscaron BE,…)

• Alternative methode of surgery of cervico mediastinal tumor described by Akashi A. and et al in which complete resection of these tumor is performed by VATS + supraclavicular approach.

• First discription: 1963 by steenburg in patient with traumatic rupture of subclavian artery

• With development of these technique surgery of bronchogenic tumors with thoracic inlet involvement was performed (dartevelle P.G)

• Succeed of this technique in surgery of one stage cervicothoracic mediastinal mass removal mentioned by (Macchiarini P, Pranikoff T, Korst RJ, Coscaron BE,…)

• Alternative methode of surgery of cervico mediastinal tumor described by Akashi A. and et al in which complete resection of these tumor is performed by VATS + supraclavicular approach.

ConclusionConclusion

• Due to good exposure of neck and mediastinal great vessels and succeed in removing these tumors, we advise using this technique for approaching them.

Ofcourse it is obvious that more studies are needed in future.

• Due to good exposure of neck and mediastinal great vessels and succeed in removing these tumors, we advise using this technique for approaching them.

Ofcourse it is obvious that more studies are needed in future.