Transcervical, paratracheal approach for an upper mediastinal mass.

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  • 非開胸下に摘出した上縦隔発生神経原性腫ようの１手術例

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We obtained satisfactory results in a 71-year-old woman using the transcervical, paratracheal approach, which is a minimally invasive method. The patient had an abnormal shadow on a chest roentogenogram in May 2000. The shadow was checked with chest roentgenograms and computed tomograms (CT) every 3 months. The patient sought surgical treatment in September 2001, because of slight enlargement of the abnormal shadow. A chest roentogenogram revealed a tumor in the left upper thoracic space. Thoracic CT revealed a round homogenous mass, 2.5×2.0 cm in size, in contact with the first and second left thoracic vertebrae. The tumor was diagnosed on imaging as a neurogenic tumor, and the patient underwent surgery in October 2001. Under general anesthesia in the supine position, a 7-cm left cervical incision was made. The platysma and left-sided anterior cervical muscles were cut, and the sternocleidomastoid muscle was spared. This muscle and the left carotid artery were retracted to expose the left pleural cupula region. The tumor arising from the sympathetic trunk was identified. The junction between the tumor and sympathetic trunk could not be freed. Therefore, the tumor was removed with the sympathetic trunk. The histological diagnosis of the tumor was schwannoma. The patient was discharged 5 days later, and the blepharoptosis disappeared 6 months after surgery.

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