Open surgery for posterior mediastinal neurogenic tumors

Although most of the posterior mediastinal masses are found incidentally in adults, neurogenic tumors are the most common mediastinal tumors in children. The rate of malignancy may be as high as 50% in children, whereas, neurogenic tumors are almost always benign in adults. Open surgery is indicated in large-sized tumors (>6 cm), in the presence of a previous thoracic surgery, or when the tumor is presumed to invade the spinal canal or spinal artery, or is apically located (close to the satellite ganglion, and great vessel). Level of the location, the size of the tumor and its relations to neural foramina and spinal canal are used to determine the incisions and surgical approach. Two different methods were described for these tumors with clinical or radiological signs of spinal canal involvement. These methods name are Akwari and Grillo’s technique. However, approaches depend on surgeon’s preferences and experiences. Theoretically one posterior incision is appropriate for small size tumors. When tumors are larger or multiple vertebral foramens are involved Akwari method is preferable according to our experience. Radicular pain, atelectasis, phrenic nerve palsy, and Horner’s Syndrome are among the commonest complications. For tumors with intraspinal extension, cerebrospinal fluid (CSF) leak is a frightening complication. Management and identification of these complications needs experience.