Alternative surgical approaches for apical neurinomas: a thoracoscopic approach.
BACKGROUND
Neural tumors at the thoracic apex present technical problems for surgeons because of their inaccessibility and postoperative neural complications. Although several approaches offering better accessibility have been proposed, none have become standard.


METHODS
Between 1976 and 2004, 23 patients, histologically 20 neurilemmomas and three ganglioneuromas, underwent surgical intervention for apical neurinoma. Surgical approaches were in three groups: (1) open thoracotomy, 8 patients; (2) transcervical, 10 patients; and (3) video-assisted thoracoscopy utilizing intracapsular enucleation to preserve important nerves and vessels, 5 patients. Perioperative variables and postoperative neurological complications were reviewed and compared among the groups.


RESULTS
Operation time and t blood loss in the vessels group were significantly less than in the other groups. Multivariate analysis with the perioperative variables showed the transcervical approach to be an independent predictor for postoperative neurologic complications (p = 0.0029). All patients remain free from recurrence, even in the follow-up period for patients in the vessels group ranging from 6 to 60 months (average, 35 months).


CONCLUSIONS
Video-assisted thoracoscopic intracapsular enucleation, when an apical neurinoma is benign and well-capsulated, is the optimal treatment to preserve nerve function. Careful follow-up to monitor for recurrence is necessary.
Division of General Thoracic Surgery, Department of Surgery, Jichi Medical School, Minamikawachi-machi, Tochigi, Japan. tcvshun@jichi.ac.jp
Shunsuke
S
Endo
Fumio
F
Murayama
Shin-ichi
S
Otani
Kenji
K
Tetsuka
Tsuyoshi
T
Hasegawa
Yukio
Y
Sato
Yasunori
Y
Sohara
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery*; D013899:Thoracic Neoplasms / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted