title: 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.
authors.affiliation: From the Division of Thoracic Surgery† and Cardiac Surgery*, University Vita-Salute and Scientific Institute, H San Raffaele, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Ciriaco
authors.forename: Giampiero
authors.initials: G
authors.lastname: Negri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bandiera
authors.forename: Monica
authors.initials: M
authors.lastname: Casiraghi
authors.forename: Luca
authors.initials: L
authors.lastname: Ferla
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
authors.forename: Piero
authors.initials: P
authors.lastname: Zannini