Uni-portal video-assisted thoracoscopic surgical (VATS) resection of giant paravertebral thoracic schwannomas: a multidisciplinary surgical approach in three cases

Abstract

Introduction Mediastinal neurogenic tumors account for 10-20% of mediastinal masses, with schwannomas being the most common in the posterior mediastinum. These benign peripheral nerve sheath tumors can pose significant surgical challenges due to their proximity to critical structures and their extension into or through the intervertebral foramen. The emergence of minimally invasive surgical techniques, such as video-assisted thoracoscopic surgery (VATS), offer a treatment option with reduced morbidity and faster recovery compared to open thoracotomy. However, reports on uni-portal VATS for thoracic schwannomas remain scarce. Case presentation We report three cases of giant paravertebral thoracic schwannomas successfully resected via uni-portal VATS. The first case involved a 54-year-old female undergoing oncological staging for thyroid carcinoma, where a 3.6 x 3.4 cm lesion at T2-T3 was incidentally discovered. The second case was a 53-year-old male with thoracic nerve root compression symptoms and a 3.1 x 2.0 cm lesion at T3-T4. The last 48-year-old female patient experienced right-sided brachialgia from a heterogeneously mass along the right T1 nerve root of 3.2 x 2.8 cm. A multidisciplinary team of thoracic surgeons and neurosurgeons performed a uni-portal VATS resection. Patients had an uneventful recovery, apart from a prolonged air leak managed conservatively in the second patient. Histopathological analysis confirmed benign schwannomas in all cases. Conclusion These cases demonstrate that uni-portal VATS is a safe and effective technique for the resection of paravertebral thoracic schwannomas. Uni-portal VATS offers significant advantages, including reduced morbidity and faster recovery. Multidisciplinary collaboration is essential to achieve favorable outcomes, particularly for tumors near critical neurovascular structures. Further studies are needed to compare outcomes with other surgical techniques and validate its broader application.