Ann Thorac Surg 1995;59:472
© 1995 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Hermes C. Grillo, MD
Department of Thoracic Surgery Massachusetts General Hospital Thoracic Surgical Unit/Warren 1101 55 Fruit St Boston, MA 02114
See also page 469.
Doctors Vallières, Findlay, and Fraser combine two recognized procedures—laminectomy and thoracoscopic resection of a posterior mediastinal tumor—to simplify removal of dumbbell neurogenic tumors. Because thoracotomy is notoriously responsible for prolonged postoperative pain, this approach has merit. As emphasized by Vallières and associates, thoracoscopic approach is inappropriate in the presence of findings suggesting malignancy. This important principle is preserved: dumbbell neurogenic tumors should be removed at a single sitting—and not in separately scheduled neurosurgical and thoracic surgical operations. Vallières and associates also demonstrated an appropriate readiness to intervene via thoracotomy when hemorrhage occurred in 1 case. Excessive difficulty in dissection, which may predict unexpected low-grade malignancy, should direct the surgeon similarly. In one rare situation—where the spinal extension may be removed by foramenotomy via the transthoracic incision above—laminectomy could be avoided. This exchange can be debated.
Related Article
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Combined Microneurosurgical and Thoracoscopic Removal of Neurogenic Dumbbell Tumors
- Eric Vallières, J. Max Findlay, and Ronald E. Fraser
Ann. Thorac. Surg. 1995 59: 469-472.
[Abstract]
[Full Text]
