Extended sternotomy with lateral neck incision: An alternative approach for children with large apical chest masses with thoracic inlet extension
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In brief
In brief
This case report describes a novel surgical technique combining extended sternotomy with lateral neck incision for resecting large apical chest masses extending into the thoracic inlet in children. Two successful cases demonstrate improved exposure compared to traditional anterior or posterior approaches for tumors involving the brachial plexus and thoracic inlet structures.
Written by the GCMD Library team from the article.
Abstract
Pediatric tumors in the apex of the thoracic cavity are often diagnosed late due to the absence of symptoms. These tumors can be quite large at presentation with involvement of the chest wall, sympathetic chain, spine, and aortic arch. The tumors can also extend into the thoracic inlet and encircle the brachial plexus. Depending on the diagnosis, treatment may involve chemotherapy with subsequent surgery or require primary resection. Optimal exposure to resect large apical tumors with thoracic inlet extension is a surgical challenge. To date, several surgical techniques have been described to resect these tumors – including both anterior and posterior thoracic approaches. Each of these techniques can be limited by inadequate exposure of the mass. We describe an alternative approach to surgical resection of these masses that employs an extended sternotomy with a lateral neck incision. This report details two successful resections of large left apical masses with thoracic inlet involvement in children using this technique (Level of evidence 4).