Neurogenic Tumors

Mediastinal neurogenic tumors constitute 10-34% of all mediastinal tumors. It comprises 35-45% of all primary mediastinal tumors in children and 11-21% in adults. 90% of mediastinal neurogenic tumors are located in the posterior mediastinum.

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These tumors are as follows:

  • Nerve sheath cells
    • Schwannoma: It is the most common neurogenic tumor in adults. It constitutes approximately 75% of all tumors in this region. They are benign tumors.
    • Neurofibroma
    • Granular Cell Tumor
    • Neurosarcoma
  • Autonomic (sympathetic) ganglia
    • Ganglioneuroma
    • Neuroblastoma
    • Ganglioneuroblastoma
  • Originates from paraganglionic structures.
    • Pheochromocytoma

Approximately 70-80% of them are benign, and about half of the cases are asymptomatic. Neurologenic tumors are usually asymptomatic and are usually diagnosed during routine radiological examinations.

Nörojenik Tümörler

Diagnosis of Neurogenic Tumors

  • Chest X-ray
  • Lateral chest radiography
  • Thorax CT
  • Magnetic resonance (MR)
  • If there is a suspicion of malignancy, PET -CT is required.

Computed tomography (CT) can clearly show that the tumor is extradural and extraspinal (how far the mass has entered the vertebral canal, whether it is compressing the dura); if it is visible, we do not perform further analysis. If it is not visible, then MR imaging can evaluate the extension of these neurogenic tumors to the intraspinal canal and helps in the differentiation of tumor types.

Treatment of Neurogenic Tumors

The treatment of mediastinal neurogenic tumors is surgical removal.

  • First choice in neurogenic mediastinal tumors: Minimally Invasive Surgery Methods
    • Robotic Surgery
    • Thoracoscopic Surgery/VATS
    • Thoracotomy

Some of the advantages of Minimally Invasive Surgery Methods (Robotic and Thoracoscopic Surgeon) are as follows:

  • Less complication rate
  • Less blood loss
  • Less damage to the nerve root and dura in the spinal canal
  • Less post-operative and chronic pain
  • Faster recovery
  • An earlier discharge
  • Minor incision scars and aesthetic appearance.
Nörojenik Tümörler

1. Robotic Surgery

It has the same tiny incision and is similar to VATS. The surgeon operates with small fractions with the da Vinci Robotic Surger system. The surgeon performs the operation sitting at the console. A surgeon standing at the patient's bedside during the process helps the surgeon at the console. The surgeon operates on a 3D image, and cameras enlarge the operation area 10-12 times. These tooltips can rotate 540 degrees around their axis and mimic the wrist movements of the human hand. Removal of these mediastinal neurogenic tumors or masses by robotic surgery is more advantageous than VATS due to the abovementioned robotic features. With VATS, the tools work straight and are not flexible; with da Vinci the mass can be removed more comfortably and with fewer complications. When the tumor has an extension to a vital nerve and channel, we remove it without damaging the nerve with the help of the Robot.

Mediastinal Masses
Neurogenic Tumors
Mediastinal Masses

Figure 1: The surgeon operates while sitting at a computer console. In an operation, a surgeon and a nurse are at the patient's side and help the surgeon at the console.

Neurogenc Tumors

Figure 2. View of Robotic entry points and ports of Robotic surgery.

2. Thoracoscopic /VATS

It is the most preferred method. It is performed with a closed method by entering through two or three incisions. It is aesthetic, the early and late period chronic pain is less, and the patient is discharged early.

3. Thoracotomy

Sometimes thoracotomy is preferred for the removal of these neurogenic tumors. In cases where tumors extend into the spinal canal and spread to the intervertebral foramen, safe resection can be performed with a combined thoracic and posterior spinal approach (with Neurosurgery).

Note: Robotic surgery is our first choice for neurogenic tumors. It has many advantages.

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