One-stage resection for massive cervicomediastinal hygroma.

Cervicomediastinal cystic hygroma has long been recognized as a serious cause of respiratory distress in infancy. This report describes the management of ten infants and children with large cervicomediastinal hygromas. Ages ranged from the newborn to 4 years (average 18.4 months). Six were boys and four were girls. Eight presented with respiratory distress. Neck examination, ultrasonography, and chest x-ray examination were usually diagnostic. In four infants the intrathoracic component was initially clinically unsuspected. The neck lesion descends into the chest between the subclavian vein and artery. At operation the mass was dissected off the pericardium; phrenic, vagus, and recurrent laryngeal nerves; esophagus; aortic arch; and subclavian vessels. Complete resection was possible in each case. Nine of ten patients survived. Death occurred in a newborn with bilateral tumor and pulmonary hypoplasia. Three patients developed Horner's syndrome. There were no recurrences (follow-up 9 months to 10 years). These data indicate that a one-stage resection using an inverted hockey stick (sternum-splitting) incision is well tolerated, curative, and superior to other methods of treatment in infants with cervicomediastinal cystic hygroma.