Dr. R. Bagheri

1. Anterior Trans cervicothoracic approach for complete resection of cervicothoracic mediastinal tumors Dr. R. Bagheri Thoracic surgeon-Assistant professor Of Mashhad University of Medical Sciences-IRAN Dr. M. Rajabi General surgeon-Associate professor Of Mashhad University of Medical Sciences-IRAN Dr .H. Mashhadi NeJad Neurosurgeon- Associate professor of Mashhad University of Medical Sciences-IRAN

2. Introduction • Mediastinal tumors consist of a wide spectrum of benign and malignant disease. Some of these tumors which locate in the thoracic apex can produce many problems in decision making due to developing to neck spaces, because with thoracotomy approach most of these tumors cannot be resected totally due to close attachment of these tumors with great vessels and removal of these tumors with dangerous complications and massive hemohrrages during surgery. • The goal of this study is to report the operated cases of these kinds of tumors with anterior trans cervical-thoracic approach.

3. Technique • Depending on the tumor development in neck spaces, first with on oblique incision near the SCM (Sternuclidomastoeid) muscle neck space dissection is done, In all patients the clavicula head is resected to see the subclavian vessels, Then with continuing the incision, as in partial stennotomy, the mediastinal space, is being assessed for complete removal of tumor, If needed, for complete removal of mediastinal tumor, the operation is completed with an anterior thoracotomy.

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8. Case report

9. A 10 years old girl admited to hospital because of exersional dyspena with a neck mass in chest x-ray and CT-scan

12. Biopsy of neck mass was performed and pathologist reported Ganglioneuroblastoma and patient underwent surgery by posterolateral thoracotomy approach but during the surgery subclavian artery was damaged and due to massive hemorrhage incomplete removed of tumor performed with repair of subclavian artery

14. In another stage patient underwent surgery by (ATCTA) and complete resection of tumor was performed

16. A 20 years old man with perevious history of neurofibroma (with typical skin lesion) admited to hospital became of cervico mediastinal tumors

20. Patient underwent surgery by ATCT approach and complete resection of tumor was performed

26. A 20 years old female admited to hospital because of cervicomediastinal mass biopsy was performed and report of pathologist was neurofibroma

29. Patient underwent surgery by ATCT approach and complete resection of tumor was performed (by team working with neurosurgeon) residual of tumor remained in neck became of involvement of nerve root in neck

32. Result • In all three patients tumors were completely removed by mentioned technique and only in one case an anterior thoracotomy was needed to remove the huge mediastinal tumor. Total resection of tumors were done in all 3 patients and there were no severe injuries to great vessels and all patients were discharged from hospital without any complications and are being observed for 6 months until now without tumor recurring. The median time for hospitalization was 5.5 days.

33. Discussion • First discription: 1963 by steenburg in patient with traumatic rupture of subclavian artery • With development of these technique surgery of bronchogenic tumors with thoracic inlet involvement was performed (dartevelle P.G) • Succeed of this technique in surgery of one stage cervicothoracic mediastinal mass removal mentioned by (Macchiarini P, Pranikoff T, Korst RJ, Coscaron BE,…) • Alternative methode of surgery of cervico mediastinal tumor described by Akashi A. and et al in which complete resection of these tumor is performed by VATS + supraclavicular approach.

34. Conclusion • Due to good exposure of neck and mediastinal great vessels and succeed in removing these tumors, we advise using this technique for approaching them. Ofcourse it is obvious that more studies are needed in future.