mediastinal masses 2014

Part of Mediastinum, Great Vessels and Diaphragm 14 items

Document · May 2026 · 1 min read

In brief

Comprehensive surgical lecture on thoracoscopic approaches to pediatric mediastinal masses, covering patient positioning, single-lung ventilation techniques, and indications for anterior vs posterior mediastinal lesions. Discusses management of neuroblastoma, teratoma, lymphoma, and foregut duplications with emphasis on minimizing morbidity and enabling earlier adjuvant therapy.

Single-lung ventilation techniques (double-lumen tube, bronchial blocker, mainstem intubation) are essential for thoracoscopic mediastinal mass resection
Patient positioning varies by lesion location: lateral for anterior masses (thymectomy, pericardial window), modified prone for posterior masses (neuroblastoma, TEF)
Contraindications to MIS approach include giant tumors, tracheal compression with respiratory compromise, and multiple bilateral nodules requiring open conversion
Posterior mediastinal masses are typically neurogenic (neuroblastoma, ganglioneuroma) while anterior masses include lymphoma, teratoma, and thymoma
Thoracoscopic resection enables accurate diagnosis, decreased morbidity, quicker recovery, and earlier initiation of adjuvant chemotherapy or radiation

Written by the GCMD Library team from the document.

Dr. Steve Rothenberg

Surgical content by Dr. Steve Rothenberg — Thoracic Surgery

Full text

Steven Rothenberg MDThe Rocky Mountain Hospital For ChildrenDenver, Colorado Vail 2018

¨Single lung ventilation: Double lumen tube Bronchial blocker Mainstem intubation Tracheal intubation w/ CO2 insufflation¨Increase in PCO2/ Increase TV & PIP

¨Maximize exposure¨Use gravity to retract lung¨Adequate access for trocars¨Don’t worry about conversion to an open thoracotomy

¨Anterior mediastinal mass¨Thymectomy¨Pericardial window¨Aortopexy

¨Posterior mediastinal mass¨TEF repair¨Myotomy¨PDA ligation¨Anterior spine exposure ¨Place NG, Bougie, Esophagoscope

Modified Prone Head Monitor MonitorSurgeonAssist Nurse

¨Tumors: Neuroblastoma, Teratoma, Lymphoma¨Cysts: Forgut Duplications, Pericardial, Thymic

¨Giant tumor¨Tracheal compression with respiratory compromise¨Inadequate resection using MIS¨Multiple nodules bilaterally

Posterior Mediastinal:Neurogenic: Neuroblastoma/ GanglioneuromaAnterior mediastinalLymphoma/ Teratoma/ Thymoma

¨Accurate diagnosis¨Decreased morbidity¨Quicker recovery¨Adjuvant therapy can begin earlier

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