被膜間および被膜下摘出により交感神経幹を温存した上縦隔交感神経鞘腫

Sympathetic Nerve Trunk Preserved by Intracapsular and Transcapsular Resection in a Patient with Superior Mediastinal Schwannoma

交感神経鞘腫は，頸部～上縦隔に発生した際にHorner症候群を呈しうる．また，症状を認めない場合でも手術後にHorner症候群などの神経症状が起こる可能性が低くない1）．上縦隔に発生した交感神経鞘腫に対して胸腔鏡下に被膜間・被膜下腫瘍摘出術を施行し，交感神経幹を温存した症例を報告する．

A 52-year-old man was referred to our hospital because of an abnormal shadow on a chest X-ray. He was asymptomatic. Computed tomography （CT） revealed a smooth 32 mm right superior mediastinal mass at the level of the first to third thoracic vertebrae. T2 magnetic resonance imaging （MRI） revealed a cystic mass with a fluid level. Foregut cysts were initially considered. After three years, the mass had enlarged to 39 mm. Thoracoscopic surgery was performed, and the mass was originated from a sympathetic trunk and removed via intracapsular and transcapsular resection. A histological examination confirmed a diagnosis of schwannoma. The patient experienced no postoperative neurological complications. Intracapsular and transcapsular resection of schwannomas is useful for preventing nerve and vascular injuries.