Supraclavicular-median sternotomy approach for a large neurilemmoma invading the thoracic outlet: a case report and review of the literature

Large mediastinum tumors invading the thoracic outlet have consistently been a challenge in thoracic surgery. Due to the large size of the tumor and its proximity to many important tissues, appropriate surgical approaches are crucial for a successful surgery.

Here, we present a case of a large neurilemmoma that invaded the thoracic outlet that was resected by a supraclavicular-median sternotomy approach. The case was a 58-year-old woman with a large mass in the right chest cavity that had invaded the thoracic outlet. The preoperative biopsy showed a blood clot with a few fibrous connective tissues covered by a single layer of flat epithelium. There was insufficient evidence to diagnose the mass as a tumor, and imaging examinations suggested a diagnosis of solitary pleural fibroma. For good exposure of the cranial and caudal aspects of the large mass, we devised a median sternotomy combined with a supraclavicular approach and safely achieved complete resection. The patient recovered well and experienced no severe complications or functional restrictions of the upper extremity. The postoperative pathology diagnosis was a neurilemmoma.

The supraclavicular-median sternotomy approach could be an optional approach for the complete resection of large mediastinal tumors invading the thoracic outlet.