Surgical treatment of mediastinal neurogenic tumors in adults: A 10-year experience

Background: Neurogenic tumors are often observed in the paravertebral sulcus. They are generally benign in adults and are good candidates for resection by video-assisted thoracic surgery (VATS). We review our series of thoracic neurogenic tumors, focusing on their surgical management. Methods: The medical charts of 25 patients with mediastinal neurogenic tumors, treated from September 1997 to January 2008, were reviewed regarding the radiographic presentation, histopathology, and surgical treatment of these tumors. Results: The patients included 16 men and nine women (mean age, 41 years; range, 20-65 years). Seventeen patients were pathologically diagnosed with schwannomas, three with neurofibromas, and five with ganglioneuromas. The median tumor size was 6.2 cm (range, 1.9-15 cm). The tumors were located in the paravertebral sulcus in 19 patients, chest wall in five patients, and visceral compartment in one patient. Seventeen patients (68%) underwent resection via standard thoracotomy, whereas the remaining were resected with VATS, including one with robotic VATS. The postoperative hospital stay was shorter in patients treated with VATS than in those treated with thoracotomy. There were no tumor-related deaths or recurrence during follow-up. Conclusion: As expected, the most frequent mediastinal neurogenic tumor was schwannoma originating from the sympathetic chains. Infrequently, tumors may arise from the vagus nerve in the visceral compartment of the mediastinum or from an intercostal nerve if they are located at sites distant from the mediastinum. VATS is a good alternative for mediastinal neurogenic tumors smaller than 5 cm or that preoperatively lack features of intraspinal extension.