Transmanubrial osteomuscular-sparing approach for neck and mediastinal neurofibroma

Abstract

We report a case of neck and mediastinal neurofibroma in a 23-year-old woman, who had been diagnosed with neurofibromatosis type 1 (NF1) in childhood. The patient presented with swelling of the parotid gland and neck and a mediastinal tumor. A physical examination identified café-au-lait spots and Lisch nodules. Preoperative computed tomography revealed a 70×53-mm tumor ranging from the neck to the tracheal bifurcation. Fluoro-2-deoxyglucose positron emission tomography revealed partial uptake in the parotid gland, superior sulcus tumor, and neck to the mediastinal tumor, indicating malignancy. The superior sulcus tumor was successfully excised without damage from the subclavian vessels and brachial plexus via a transmanubrial approach, and the neck to the mediastinal tumor was excised via this and a videothoracoscopic approach. The pathological findings indicated non-malignant neurofibromas. Our experience revealed that the transmanubrial approach was valuable as an operative procedure for excising a superior sulcus tumor.