title: [Cervico-sternotomy for thoracic inlet conditions in children].
abstract: OBJECTIVE
  Neither cervicotomy nor postero-lateral thoracotomy allow safe surgical access to the lower cervical spine and high posterior mediastinum with full control of the vascular and neural structures involved. We report our favorable experience with cervico-sternotomy for accessing this region.
  
  
  METHODS
  Six patients were operated upon between 1998 and 2011 for either removal of huge cervico-thoracic neural ganglioneuromas (n = 2) or anterior arthrodesis for congenital (n = 2), neuropathic (n = 1) or osteolytic scoliosis (n = 1). In all cases, cervicotomy was followed by sternotomy, thymectomy, division of the innominate vein and dissection of jugular veins, carotid arteries and vagus nerves.
  
  
  RESULTS
  The tumors measured 10.9 x 3.9 x 8.7 cm and 8 x 6 x 5 cm, and involved the paravertebral chain from the aortic arch to the base of the skull and from the left lung hilus to the thyroid region respectively. In the scoliosis patients, anterior vertebral fixation between C5 and T5 was readily feasible. Blood transfusion was avoided. Horner's syndrome and transient lymphedema were the only complications. Median operative time was 210 minutes (range 180-240 minutes) and median estimated blood loss was 2.7 cc/kg (0-13.8 cc/kg). Median hospital stay was 7 days (range 5-18 days).
  
  
  CONCLUSIONS
  Cervico-sternotomy is an optimal approach for this anatomical region in children. It offers better exposure of the anterior cervico-thoracic spine and the thoracic inlet than cervicotomy or thoracotomy. Control of the nervous and vascular structures was safely achieved in all cases and postoperative discomfort was surprisingly limited.
authors.forename: R
authors.initials: R
authors.lastname: Ortiz
authors.forename: E
authors.initials: E
authors.lastname: Domínguez
authors.forename: S
authors.initials: S
authors.lastname: López Fernández
authors.forename: M
authors.initials: M
authors.lastname: Miguel
authors.forename: F Sánchez
authors.initials: FS
authors.lastname: Pérez-Grueso
authors.forename: L
authors.initials: L
authors.lastname: Martínez
authors.forename: J A
authors.initials: JA
authors.lastname: Tovar
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion; D056346:Sternotomy