Mediastinal neurogenic tumors and video-assisted thoracoscopy: always the right choice?

Neurogenic mediastinal tumors in adults are generally benign lesions and for this reason are ideal candidates for resection by video-assisted thoracoscopy (VAT). Usual contraindications to VAT are the dimension of the tumor (greater than 6 cm), its position (apex, posterior costodiaphragmatic angle), and/or the presence of intraspinal growth (the so-called "dumbbell tumors"). This study reviewed a single-institution 10-year experience approaching mediastinal neurogenic tumors routinely by VAT, even in cases of the above mentioned contraindications. From January 1992 to December 2002, 15 consecutive mediastinal neurogenic tumors were operated by VAT (11 females, mean age 43 years, range 16-67). Mean operating time was 99 minutes (range 60-180). No conversion thoracotomy was required. The 2 cases of "dumbbell tumor" in this series were treated by laminectomy followed by VAT. Two patients had a Claude-Bernard-Horner syndrome after removal of lesion at the level of T1-T2. Mean postoperative stay was 5.5 days. Histologic diagnosis was schwannoma in 12 cases (Antoni type A in 7 cases, type B in 4 cases, mixed type in 1 case) and neurofibroma in 3 cases. Results from this 10-year experience confirmed that VAT can be the standard approach for neurogenic tumors in adults without negative effect on radicality of resection and safety of the procedure.