Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands.
Multimed Man Cardiothorac Surg. 2023 May 22;2023. doi: 10.1510/mmcts.2023.010.
Paragangliomas are tumours originating from the autonomic nervous system and rarely occur in the chest. They may manifest through symptoms of excess catecholamine release or due to local compression, can be an incidental finding on a computed tomography/magnetic resonance imaging examination or can be found when screening patients with specific gene mutations. Surgical removal is indicated in case of symptoms, (imminent) compression of vital structures or to prevent progression to malignancy. Resection of a paraganglioma in the middle mediastinum can be challenging. The relationship of the tumour to vital structures and its blood supply determine the surgical access route. In this case report, a large paraganglioma situated in the middle mediastinum is resected. Because of the close relationship to vital structures and the presence of feeding arteries from the aortic arch, a transsternal transpericardial approach is chosen. After a median sternotomy, stepwise dissection between the aorta, superior caval vein and right pulmonary artery and the opening of the posterior pericardium gives access to the middle mediastinum and the area between the tracheal bifurcation and the left atrial roof. These steps can be done without cardiopulmonary bypass. After identification and division of the feeding aortic arch arteries, the highly vascularized tumour can be further dissected and removed.
副神经节瘤起源于自主神经系统，很少发生在胸部。它们可能表现为儿茶酚胺释放过多的症状，也可能由于局部压迫引起，还可能在计算机断层扫描/磁共振成像检查中偶然发现，也可能在筛查具有特定基因突变的患者时发现。如果出现症状、（即将）压迫重要结构或为了防止恶变，就需要进行手术切除。位于纵隔中部的副神经节瘤切除术具有挑战性。肿瘤与重要结构的关系及其血供决定了手术入路。在本病例报告中，切除了位于纵隔中部的一个大副神经节瘤。由于与重要结构关系密切，并且存在发自主动脉弓的供养动脉，因此选择经胸骨正中切开经心包的入路。正中劈开胸骨后，在主动脉、上腔静脉和右肺动脉之间逐步解剖，并打开心包后腔，即可进入纵隔中部和气管分叉与左心房顶之间的区域。这些步骤无需体外循环即可完成。在确认并分离供养主动脉弓的动脉后，即可进一步解剖和切除高度血管化的肿瘤。
