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Posterior Mediastinal Tumors

  • Keith S. Naunheim
  • Melanie A. Edwards
Chapter

Abstract

The posterior mediastinum begins at the posterior pericardium and ends at the anterior longitudinal ligament. The thoracic inlet and diaphragm, respectively, form the superior and inferior extent, and the pleural reflections comprise the lateral margins. Within this space lies the oesophagus, descending thoracic aorta, thoracic duct, azygos and hemiazygos veins, nerve roots, sympathetic nerves, and proximal intercostal nerves and vessels [1]. The pathologic processes found in the posterior mediastinum vary according to age; 50–75% of posterior mediastinal tumors are of neurogenic origin in infants and adults (up to 95%), while lymphoma is more common in adolescents. Most tumors found in adults originate from the peripheral nerve sheath and are benign [2]. In the pediatric population, posterior neurogenic tumors comprise a greater proportion of all thoracic tumors, and up to 60% are malignant [1, 3].

Keywords

Mediastinal neoplasm Mediastinal cyst Neurilemmoma Ganglioneuroma Neuroblastoma Thoracoscopy Thoracic surgery Video assisted 

References

  1. 1.
    Pearson FG, Patterson GA. Pearson’s thoracic & esophageal surgery. 3rd ed. Philadelphia: Churchill Livingstone/Elsevier; 2008.Google Scholar
  2. 2.
    Reeder LB. Neurogenic tumors of the mediastinum. Semin Thorac Cardiovasc Surg. 2000;12(4):261–7.  https://doi.org/10.1053/stcs.2000.16738.CrossRefPubMedGoogle Scholar
  3. 3.
    Kelemen JJ, Naunheim KS. Minimally invasive approaches to mediastinal neoplasms. Semin Thorac Cardiovasc Surg. 2000;12(4):301–6.  https://doi.org/10.1053/stcs.2000.17919.CrossRefPubMedGoogle Scholar
  4. 4.
    Akwari OE, Payne WS, Onofrio BM, Dines DE, Muhm JR. Dumbbell neurogenic tumors of the mediastinum. Diagnosis and management. Mayo Clin Proc. 1978;53(6):353–8.PubMedGoogle Scholar
  5. 5.
    Nakazono T, White CS, Yamasaki F, Yamaguchi K, Egashira R, Irie H, et al. MRI findings of mediastinal neurogenic tumors. Am J Roentgenol. 2011;197(4):W643–W52.  https://doi.org/10.2214/AJR.10.6119.CrossRefGoogle Scholar
  6. 6.
    Sakai F, Sone S, Kiyono K, Maruyama A, Ueda H, Aoki J, et al. Intrathoracic neurogenic tumors: MR-pathologic correlation. AJR Am J Roentgenol. 1992;159(2):279–83.  https://doi.org/10.2214/ajr.159.2.1632340.CrossRefPubMedGoogle Scholar
  7. 7.
    Pons F, Lang-Lazdunski L, Bonnet PM, Meyrat L, Jancovici R. Videothoracoscopic resection of neurogenic tumors of the superior sulcus using the harmonic scalpel. Ann Thorac Surg. 2003;75(2):602–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Furak J, Geczi T, Tiszlavicz L, Lazar G. Postoperative paraplegia after resection of a giant posterior mediastinal tumour. Importance of the blood supply in the upper spinal cord. Interact Cardiovasc Thorac Surg. 2011;12(5):855–6.  https://doi.org/10.1510/icvts.2010.257105.CrossRefPubMedGoogle Scholar
  9. 9.
    Grillo HC, Ojemann RG, Scannell JG, Zervas NT. Combined approach to “dumbbell” intrathoracic and intraspinal neurogenic tumors. Ann Thorac Surg. 1983;36(4):402–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Nordin AB, Fallon SC, Jea A, Kim ES. The use of spinal angiography in the management of posterior mediastinal tumors: case series and review of the literature. J Pediatr Surg. 2013;48(9):1871–7.  https://doi.org/10.1016/j.jpedsurg.2013.04.029.CrossRefPubMedGoogle Scholar
  11. 11.
    Shamji MF, Maziak DE, Shamji FM, Ginsberg RJ, Pon R. Circulation of the spinal cord: an important consideration for thoracic surgeons. Ann Thorac Surg. 2003;76(1):315–21.  https://doi.org/10.1016/s0003-4975(03)00139-5.CrossRefPubMedGoogle Scholar
  12. 12.
    Shadmehr MB, Gaissert HA, Wain JC, Moncure AC, Grillo HC, Borges LF, et al. The surgical approach to “dumbbell tumors” of the mediastinum. Ann Thorac Surg. 2003;76(5):1650–4.  https://doi.org/10.1016/s0003-4975(03)00882-8.CrossRefPubMedGoogle Scholar
  13. 13.
    Landreneau RJ, Dowling RD, Ferson PF. THoracoscopic resection of a posterior mediastinal neurogenic tumor. Chest. 1992;102(4):1288–90.  https://doi.org/10.1378/chest.102.4.1288.CrossRefPubMedGoogle Scholar
  14. 14.
    Bousamra IIM, Haasler GB, Patterson GA, Roper CL. A comparative study of thoracoscopic vs open removal of benign neurogenic mediastinal tumors. Chest. 1996;109(6):1461–5.  https://doi.org/10.1378/chest.109.6.1461.CrossRefPubMedGoogle Scholar
  15. 15.
    Demmy TL, Krasna MJ, Detterbeck FC, Kline GG, Kohman LJ, DeCamp MM Jr, et al. Multicenter VATS experience with mediastinal tumors. Ann Thoracic Surg. 1998;66(1):187–92.  https://doi.org/10.1016/S0003-4975(98)00378-6.CrossRefGoogle Scholar
  16. 16.
    Roviaro G, Varoli F, Nucca O, Vergani C, Maciocco M. Videothoracoscopic approach to primary mediastinal pathology. Chest. 2000;117(4):1179–83.  https://doi.org/10.1378/chest.117.4.1179.CrossRefPubMedGoogle Scholar
  17. 17.
    Zierold D, Halow KD. Thoracoscopic resection as the preferred approach to posterior mediastinal neurogenic tumors. Surg Laparosc Endosc Percutan Tech. 2000;10(4):222–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Arapis C, Gossot D, Debrosse D, Arper L, Mazel C, Grunenwald D. Thoracoscopic removal of neurogenic mediastinal tumors: technical aspects. Surg Endosc. 2004;18(9):1380–3.  https://doi.org/10.1007/s00464-003-9329-9.CrossRefPubMedGoogle Scholar
  19. 19.
    Kan P, Schmidt MH. Minimally invasive thoracoscopic resection of paraspinal neurogenic tumors. Neurosurgery. 2008;63:ONSE54.  https://doi.org/10.1227/01.neu.0000313118.73941.d7.CrossRefPubMedGoogle Scholar
  20. 20.
    Li Y, Wang J. Experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumours: a retrospective analysis of 58 patients. ANZ J Surg. 2013;83(9):664–8.  https://doi.org/10.1111/j.1445-2197.2012.06174.x.CrossRefPubMedGoogle Scholar
  21. 21.
    Ricci C, Rendina EA, Venuta F, Pescarmona EO, Gagliardi F. Diagnostic imaging and surgical treatment of dumbbell tumors of the mediastinum. Ann Thorac Surg. 1990;50(4):586–9.  https://doi.org/10.1016/0003-4975(90)90194-B.CrossRefPubMedGoogle Scholar
  22. 22.
    Yang C, Zhao D, Zhou X, Ding J, Jiang G. A comparative study of video-assisted thoracoscopic resection versus thoracotomy for neurogenic tumours arising at the thoracic apex. Interact Cardiovasc Thorac Surg. 2015;20(1):35–9.  https://doi.org/10.1093/icvts/ivu328.CrossRefPubMedGoogle Scholar
  23. 23.
    Naunheim KS. Video thoracoscopy for masses of the posterior mediastinum. Ann Thorac Surg. 1993;56(3):657–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Hazelrigg SR, Landreneau RJ, Mack MJ, Acuff TE. Thoracoscopic resection of mediastinal cysts. Ann Thorac Surg. 1993;56(3):659–60.CrossRefPubMedGoogle Scholar
  25. 25.
    Fraga JC, Aydogdu B, Aufieri R, Silva GV, Schopf L, Takamatu E, et al. Surgical treatment for pediatric mediastinal neurogenic tumors. Ann Thorac Surg. 2010;90(2):413–8.  https://doi.org/10.1016/j.athoracsur.2010.04.086.CrossRefPubMedGoogle Scholar
  26. 26.
    Fraga JC, Rothenberg S, Kiely E, Pierro A. Video-assisted thoracic surgery resection for pediatric mediastinal neurogenic tumors. J Pediatr Surg. 2012;47(7):1349–53.  https://doi.org/10.1016/j.jpedsurg.2012.01.067.CrossRefPubMedGoogle Scholar
  27. 27.
    Guye E, Lardy H, Piolat C, Bawab F, Becmeur F, Dyon JF, et al. Thoracoscopy and solid tumors in children: a multicenter study. J Laparoendosc Adv Surg Tech A. 2007;17(6):825–9.  https://doi.org/10.1089/lap.2007.0043.CrossRefPubMedGoogle Scholar
  28. 28.
    Lacreuse I, Valla JS, de Lagausie P, Varlet F, Héloury Y, Temporal G, et al. Thoracoscopic resection of neurogenic tumors in children. J Pediatr Surg. 2007;42(10):1725–8.  https://doi.org/10.1016/j.jpedsurg.2007.05.030.CrossRefPubMedGoogle Scholar
  29. 29.
    Partrick DA, Rothenberg SS. Thoracoscopic resection of mediastinal masses in infants and children: an evaluation of technique and results. J Pediatr Surg. 2001;36(8):1165–7.  https://doi.org/10.1053/jpsu.2001.25740.CrossRefPubMedGoogle Scholar
  30. 30.
    Petty JK, Bensard DD, Partrick DA, Hendrickson RJ, Albano EA, Karrer FM. Resection of neurogenic tumors in children: is thoracoscopy superior to thoracotomy? J Am Coll Surg. 2006;203(5):699–703.  https://doi.org/10.1016/j.jamcollsurg.2006.07.022.CrossRefPubMedGoogle Scholar
  31. 31.
    Barrenechea IJ, Fukumoto R, Lesser JB, Ewing DR, Connery CP, Perin NI. Endoscopic resection of thoracic paravertebral and dumbbell tumors. Neurosurgery. 2006;59(6):1195–201; discussion 1201–2.  https://doi.org/10.1227/01.NEU.0000245617.39850.C9.CrossRefPubMedGoogle Scholar
  32. 32.
    Savitt MA, Gao G, Furnary AP, Swanson J, Gately HL, Handy JR. Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum. Ann Thorac Surg. 2005;79(2):450–5; discussion 455.  https://doi.org/10.1016/j.athoracsur.2004.07.022.CrossRefPubMedGoogle Scholar
  33. 33.
    Seong YW, Kang CH, Choi JW, Kim HS, Jeon JH, Park IK et al. Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: its superiority over a conventional sternotomy approach evaluated by propensity score matching. Eur J Cardiothorac Surg. 2014;45(3):e68–73; discussion e73.  https://doi.org/10.1093/ejcts/ezt557.CrossRefPubMedGoogle Scholar
  34. 34.
    Cerfolio RJ, Bryant AS, Minnich DJ. Operative techniques in robotic thoracic surgery for inferior or posterior mediastinal pathology. J Thorac Cardiovasc Surg. 2012;143(5):1138–43.  https://doi.org/10.1016/j.jtcvs.2011.12.021.CrossRefPubMedGoogle Scholar
  35. 35.
    Negri G, Puglisi A, Gerevini S, Voci C, Zannini P. Thoracoscopic techniques in the management of benign mediastinal dumbbell tumors. Surg Endosc. 2001;15(8):897.  https://doi.org/10.1007/s004640042001.CrossRefPubMedGoogle Scholar
  36. 36.
    Venissac N, Leo F, Hofman P, Paquis P, Mouroux J. Mediastinal neurogenic tumors and video-assisted thoracoscopy: always the right choice? Surg Laparosc Endosc Percutan Tech. 2004;14(1):20–2.CrossRefPubMedGoogle Scholar
  37. 37.
    Konno S, Yabuki S, Kinoshita T, Kikuchi S. Combined laminectomy and thoracoscopic resection of dumbbell-type thoracic cord tumor. Spine. 2001;26(6):E130–4.CrossRefPubMedGoogle Scholar
  38. 38.
    McKenna RJ Jr, Maline D, Pratt G. VATS resection of a mediastinal neurogenic dumbbell tumor. Surg Laparosc Endosc. 1995;5(6):480–2.PubMedGoogle Scholar
  39. 39.
    Vallieres E, Findlay JM, Fraser RE. Combined microneurosurgical and thoracoscopic removal of neurogenic dumbbell tumors. Ann Thorac Surg. 1995;59(2):469–72.CrossRefPubMedGoogle Scholar
  40. 40.
    Heltzer JM, Krasna MJ, Aldrich F, McLaughlin JS. Thoracoscopic excision of a posterior mediastinal “dumbbell” tumor using a combined approach. Ann Thorac Surg. 1995;60(2):431–3.CrossRefPubMedGoogle Scholar
  41. 41.
    Maeda S, Takahashi S, Koike K, Sato M. Preferred surgical approach for dumbbell-shaped tumors in the posterior mediastinum. Ann Thora Cardiovasc Surg. 2011;17(4):394–6.CrossRefGoogle Scholar
  42. 42.
    Ng CS, Wong RH, Hsin MK, Yeung EC, Wan S, Wan IY, et al. Recent advances in video-assisted thoracoscopic approach to posterior mediastinal tumours. Surgeon. 2010;8(5):280–6.  https://doi.org/10.1016/j.surge.2010.06.001.CrossRefPubMedGoogle Scholar
  43. 43.
    Kumar A, Kumar S, Aggarwal S, Khilnani GC. Thoracoscopy: the preferred approach for the resection of selected posterior mediastinal tumors. J Laparoendosc Adv Surg Tech A. 2002;12(5):345–53.  https://doi.org/10.1089/109264202320884090.CrossRefPubMedGoogle Scholar
  44. 44.
    Epstein NE. A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery. Surg Neurol Int. 2013;4(Suppl 5):S301–17.  https://doi.org/10.4103/2152-7806.111427.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Attar S, Hankins JR, Turney SZ, Krasna MJ, McLaughlin JS. Paraplegia after thoracotomy: report of five cases and review of the literature. Ann Thorac Surg. 1995;59(6):1410–5; discussion 1415–6.CrossRefPubMedGoogle Scholar
  46. 46.
    Saenz NC. Posterior mediastinal neurogenic tumors in infants and children. Semin Pediatr Surg. 1999;8(2):78–84.CrossRefPubMedGoogle Scholar
  47. 47.
    Wiseman GA, Pacak K, O’Dorisio MS, Neumann DR, Waxman AD, Mankoff DA, et al. Usefulness of 123I-MIBG scintigraphy in the evaluation of patients with known or suspected primary or metastatic pheochromocytoma or paraganglioma: results from a prospective multicenter trial. J Nucl Med. 2009;50(9):1448–54.  https://doi.org/10.2967/jnumed.108.058701.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Liu L, Mei J, Che G. Asymptomatic paraganglioma of the posterior mediastinum misdiagnosed until operation. Thorac Cardiovasc Surg. 2010;58(5):302–4.  https://doi.org/10.1055/s-0029-1185874.CrossRefPubMedGoogle Scholar
  49. 49.
    Suzawa K, Yamamoto H, Ichimura K, Toyooka S, Miyoshi S. Asymptomatic but functional paraganglioma of the posterior mediastinum. Ann Thorac Surg. 2014;97(3):1077–80.  https://doi.org/10.1016/j.athoracsur.2013.06.100.CrossRefPubMedGoogle Scholar
  50. 50.
    Bouhouch A, Hendriks JM, Lauwers PR, De Raeve HR, Van Schil PE. Asymptomatic pheochromocytoma in the posterior mediastinum. Acta Chir Belg. 2007;107(4):465–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Ayala-Ramirez M, Feng L, Johnson MM, Ejaz S, Habra MA, Rich T, et al. Clinical risk factors for malignancy and overall survival in patients with pheochromocytomas and sympathetic paragangliomas: primary tumor size and primary tumor location as prognostic indicators. J Clin Endocrinol Metab. 2011;96(3):717–25.  https://doi.org/10.1210/jc.2010-1946.CrossRefPubMedGoogle Scholar
  52. 52.
    Brown ML, Zayas GE, Abel MD, Young WF Jr, Schaff HV. Mediastinal paragangliomas: the Mayo Clinic experience. Ann Thorac Surg. 2008;86(3):946–51.  https://doi.org/10.1016/j.athoracsur.2008.04.105.CrossRefPubMedGoogle Scholar
  53. 53.
    Spector JA, Willis DN, Ginsburg HB. Paraganglioma (pheochromocytoma) of the posterior mediastinum: a case report and review of the literature. J Pediatr Surg. 2003;38(7):1114–6.  https://doi.org/10.1016/S0022-3468(03)00208-2.CrossRefPubMedGoogle Scholar
  54. 54.
    Kitagawa RS, Satyan KB, Relyea K, Dauser RC, Nuchtern JG, Minifee PK, et al. Video-assisted thorascopic repair of a subarachnoid-pleural fistula in a child after thoracic tumor resection: technical note. Spine. 2010;35(9):E347–50.  https://doi.org/10.1097/BRS.0b013e3181d83538.CrossRefPubMedGoogle Scholar
  55. 55.
    Muraki S, Tanaka A, Miyajima M, Harada R, Watanabe N, Hyodoh H. Adamkiewicz artery demonstrated by MRA for operated posterior mediastinal tumors. Ann Thorac Cardiovasc Surg. 2006;12(4):270–2.PubMedGoogle Scholar
  56. 56.
    Nijenhuis RJ, Jacobs MJ, Jaspers K, Reijnders M, van Engelshoven JMA, Leiner T, et al. Comparison of magnetic resonance with computed tomography angiography for preoperative localization of the Adamkiewicz artery in thoracoabdominal aortic aneurysm patients. J Vasc Surg. 2007;45(4):677–85.  https://doi.org/10.1016/j.jvs.2006.11.046.CrossRefPubMedGoogle Scholar
  57. 57.
    Yoshioka K, Niinuma H, Ehara S, Nakajima T, Nakamura M, Kawazoe K. MR angiography and CT angiography of the artery of Adamkiewicz: state of the art. Radiographics. 2006;26(Suppl 1):S63–73.  https://doi.org/10.1148/rg.26si065506.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.St Louis University School of MedicineSt. LouisUSA
  2. 2.Division of Cardiothoracic SurgerySt Louis University School of MedicineSt. LouisUSA

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