Amir Muhammad Abid, Isahak Mohamed Izzad, Adnan Isqandar, Dimon Mohd Zamrin
Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, 47000 Selangor, Malaysia.
Department of Anaesthesiology, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, 47000 Selangor, Malaysia.
J Surg Case Rep. 2023 Sep 20;2023(9):rjad524. doi: 10.1093/jscr/rjad524. eCollection 2023 Sep.
Symptomatic giant ganglioneuromas with mediastinal compression are rare, complicating its management with significant morbidity and mortality risks. A meticulous multidisciplinary preoperative planning is pivotal in ensuring success. We describe a case of a 30-year-old man with a giant posterior mediastinal mass with compression and displacement of the mediastinal structures. Biopsy confirmed a ganglioneuroma and patient underwent excision. Surgery was challenging in view of the size and adherence to the local structures. Haemodynamic instabilities were encountered necessitating a pre-emptive femoral-femoral cannulation for CPB. A piece-meal debulking of the tumour was performed, complicated with massive haemorrhage requiring autologous blood transfusion using an intraoperative blood salvage device. The patient recovered and was discharged home well at Day 8. A thorough pre-operative planning involving a multidisciplinary approach, an understanding of the surgical anatomy as well as anticipating impending complications is of paramount importance in the management of this particular case.
有纵隔压迫症状的巨大神经节瘤很罕见，其治疗复杂，存在显著的发病和死亡风险。精心的多学科术前规划对于确保手术成功至关重要。我们描述了一例30岁男性患者，其患有巨大的后纵隔肿块，伴有纵隔结构受压和移位。活检证实为神经节瘤，患者接受了切除手术。鉴于肿瘤大小以及与局部结构的粘连，手术具有挑战性。术中出现血流动力学不稳定，因此需要预先进行股-股插管以便进行体外循环。对肿瘤进行了分次切除，术中出现大量出血，需要使用术中血液回收装置进行自体输血。患者康复，术后第8天顺利出院。对于这种特殊病例的管理，采用多学科方法进行全面的术前规划、了解手术解剖结构以及预见即将出现的并发症至关重要。
