Advertisement

European Spine Journal

, Volume 27, Issue 4, pp 902–912 | Cite as

Paravertebral tumours of the cervicothoracic junction extending into the mediastinum: surgical strategies in a no man’s land

  • Georgios K. Prezerakos
  • Parag Sayal
  • Antonios Kourliouros
  • Periclis Pericleous
  • George Ladas
  • Adrian Casey
Original Article
  • 167 Downloads

Abstract

Purpose

Cervicothoracic paravertebral neoplasms extending into the mediastinum pose a surgical challenge due the complex regional anatomy, their biological nature, rarity and surgeon’s unfamiliarity with the region. We aim to define a surgical access framework addressing the aforementioned complexities whilst achieving oncological clearance.

Methods

We carried out a retrospective review of 28 consecutive patients operated in two tertiary referral centres between 1998 and 2015. Pathology was located paravertebrally from C6 to T4 with superior mediastinum invasion. Patients were operated jointly by a spinal and a thoracic surgeon.

Results

Tumours were classified according to subclavian fossa involvement as anteromedial, anterolateral and posterior and according to histology in benign nerve sheath tumour group (n = 10) and malignant bone or soft tissue tumours (n = 18). Three surgical routes were utilised: (1) median sternotomy (n = 11), (2) anterior cervical transsternal approach (n = 7) and (3) high posterolateral thoracotomy (n = 10). Resection was en bloc with wide margins in 22 cases, marginally complete in 3 and incomplete in 3. Complications included Horner’s syndrome (n = 3), infection (n = 2) and transient neurological deficit (n = 4). In the nerve sheath tumour group, no recurrence or reoperation took place with a median follow-up of 4.5 years. In the malignant bone and soft tissue group, 96% of the patients were alive at 1 year, 67% at 2 years and 33% at 5 years. No vascular injuries or operative related deaths were observed.

Conclusions

Classification of cervicothoracic paravertebral neoplasms with mediastinal extension according to the relationship with the subclavicular fossa and dual speciality involvement allows for a structured surgical approach and provides minimal morbidity/maximum resection and satisfactory oncological outcomes.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Cervicothoracic neoplasms Paravertebral tumours Thoracic outlet Sympathetic chain schwannoma Primary bone tumours 

Notes

Funding

No funding was received.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Supplementary material

586_2018_5512_MOESM1_ESM.pptx (3.8 mb)
Supplementary material 1 (PPTX 3886 kb)

References

  1. 1.
    Birch R, Bonney G, Marshall RW (1990) A surgical approach to the cervicothoracic spine. J Bone Jt Surg Br 72:904–907CrossRefGoogle Scholar
  2. 2.
    Cauchoix J, Binet JP (1957) Anterior surgical approaches to the spine. Ann R Coll Surg Engl 21:237–243PubMedPubMedCentralGoogle Scholar
  3. 3.
    Dartevelle PG, Chapelier AR, Macchiarini P, Lenot B, Cerrina J, Ladurie FL, Parquin FJ, Lafont D (1993) Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet. J Thorac Cardiovasc Surg 105:1025–1034PubMedGoogle Scholar
  4. 4.
    Grunenwald D, Spaggiari L (1997) Transmanubrial osteomuscular sparing approach for apical chest tumors. Ann Thorac Surg 63:563–566CrossRefPubMedGoogle Scholar
  5. 5.
    Ladas G, Rhys-Evans PH, Goldstraw P (1999) Anterior cervical–transsternal approach for resection of benign tumors at the thoracic inlet. Ann Thorac Surg 67:785–789CrossRefPubMedGoogle Scholar
  6. 6.
    Mazel C, Grunenwald D, Laudrin P, Marmorat JL (2003) Radical excision in the management of thoracic and cervicothoracic tumors involving the spine: results in a series of 36 cases. Spine 28:782–792PubMedGoogle Scholar
  7. 7.
    Panagopoulos N, Livaditis V, Koletsis E, Alexopoulos P, Prokakis C, Baltayiannis N, Hatzimichalis A, Tsakiridis K, Zarogoulidis P, Zarogoulidis K, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Machairiotis N, Madesis A, Vretzakis G, Kolettas A, Dougenis D (2014) Therapeutic modalities for Pancoast tumors. J Thorac Dis 6(Suppl 1):S180–S193Google Scholar
  8. 8.
    Shaw RR, Paulson DL, Kee JL (1961) Treatment of superior sulcus tumor by irradiation followed by resection. Ann Surg 154:29–40CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Yamazaki T, McLoughlin GS, Patel S, Rhines LD, Fourney DR (2009) Feasibility and safety of en bloc resection for primary spine tumors: a systematic review by the Spine Oncology Study Group. Spine 34:S31–S38CrossRefPubMedGoogle Scholar
  10. 10.
    Talac R, Yaszemski MJ, Currier BL, Fuchs B, Dekutoski MB, Kim CW, Sim FH (2002) Relationship between surgical margins and local recurrence in sarcomas of the spine. Clin Orthop Relat Res 397:127–132CrossRefGoogle Scholar
  11. 11.
    Boriani S, Saravanja D, Yamada Y, Varga PP, Biagini R, Fisher CG (2009) Challenges of local recurrence and cure in low grade malignant tumors of the spine. Spine 34:S48–S57CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Georgios K. Prezerakos
    • 1
  • Parag Sayal
    • 1
  • Antonios Kourliouros
    • 2
  • Periclis Pericleous
    • 2
  • George Ladas
    • 2
  • Adrian Casey
    • 1
  1. 1.Victor Horsley Department of NeurosurgeryNational Hospital for Neurology and NeurosurgeryLondonUK
  2. 2.Royal Brompton HospitalLondonUK

Personalised recommendations