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Thoracoscopic Resection of Two Thoracic Outlet Schwannomas
Trevor C. Upham, MD1, Conor F. Hynes, MD2, M Blair Marshall, MD2.
1University of California, San Diego, La Jolla, CA, USA, 2Georgetown University Hospital, Washington, DC, USA.

OBJECTIVE: Schwannomas are benign peripheral nerve sheath tumors that can occur anywhere in the body, but most commonly occur in the head and neck. Less frequent, they may occur in the chest. Originating mainly along the nerve roots, these tumors frequently occur in a central location that can cause local compression of critical structures for the patients and surgical access difficulty for the surgeon. While thoracotomy, sternotomy and other radical incisions can be made for excision, little information describes the thoracoscopic techniques to safely excise schwannomas at the apex of the thoracic cavity.
METHODS: Here we demonstrate two cases using a single lumen endotracheal tube, CO2 insufflation, and pediatric instruments for excision of apical schwannomas. Port placement, camera use and instrument use is highlighted in each video to minimize injury to surrounding anatomic structures.
RESULTS: Schwannomas at the apex of the chest can be excised safely using thoracoscopic techniques. Horner's syndrome is a risk of the procedure but may resolve postoperatively.
CONCLUSIONS: Thoacoscopic excision should be considered for schwannomas at the apex of the chest.

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