Surgical management of posterior mediastinal tumors with intraspinal extention

ABSTRACT

In this study, ten patients with posterior mediastinal tumors were subjected to thorough clinical and radiological examination including CT and MRI chest and thoracic spine to determine the site of the tumor and the extent of invasion of the thoracic vertebral bodies and/or their neural arches. Preoperative CT guided biopsy was done for all cases to identify the tumor pathology. The patients were followed up for a period ranging from 7 to 24 months for local or distant recurrence, spinal stability, neurological functions and the need for adjuvant therapy. Anterior approach [posterolateral thoracotomy] was done in seven patients, posterior approach was done in one case and combined anterior and posterior approaches were done in two cases. Total corpectomy alone was done in seven cases. Combined corpectomy and laminectomy were done in two cases and laminectomy alone in one case. In nine cases, dorsal spine was fixed anteriorly by instrumentation [Z-plate and screws] and iliac crest bone graft [eight cases] or isobone [one case]. In one case, fixation was done by posterolateral plates and screws and intertransverse bony fusion. All cases of fixation showed sound bony fusion. Nine cases were improved neurologically and only one case did not improve postoperatively