Assisted thoracoscopic resection of huge mediastinal neurogenic tumor with Horner syndrome and superior vena cava syndrome

A 51-year-old female suffering from right shoulder pain had chest radiography, which showed the huge round shadow (10 x 8.5 x 8.0 cm) on the right upper lung field. Horner syndrome and superior vena cava syndrome were presented. Thoracoscopic appearance showed that the tumor with complete smooth capsulation was neurogenic. After that added ideal thoracotomy (compatible with location and length) was performed, from which tumor was carried out and made a pathologic diagnosis of neurilemoma originated from thoracic sympathetic nerve. Harmonic Scalpel, an ultrasonically activated surgical device was effective in such a case of using near by nerve and small vessels. After operation, superior vena cava syndrome except for Horner syndrome was improved. It is important that we should consider less invasive and safe approach with combination of thoracoscopic and thoracotomic procedures even in case of huge tumor.