Introduction: The aim of the study is to present a rare localization of neuroblastoma in cervico-thoracic region in a pediatric patient, emphasizing the challenges and surgical strategies involved.
Case presentation: A 39-month-old infant, was incidentally found to have a 6x4.5 cm mass in the left paravertebral region at the C7-T6 level, with extension from the neural foramen to the spinal cord at the level of T1-T4 vertebra. An initial thoracoscopic biopsy revealed a ganglioneuroma, but the presence of neuroblastoma components could not be ruled out, leading to a surgical resection. In the first operation thoracotomy was performed, but complete resection could not be achieved due to close relationship with vascular structures. A laminectomy was then performed by the neurosurgery team. Pathological evaluation confirmed differentiated neuroblastoma with a low mitotic index, indicating a favorable prognosis and N-myc amplification (-). Preoperative chemotherapy was administered according to IDRF. However due to insufficient reduction of the mass, a second operation utilizing a trap-door incision was planned. This unique surgical approach involved a sternotomy with an incision extending approximately 2 cm above the clavicle and laterally to the third intercostal space, which allows isolation of the aortic arch and meticulous dissection of the subclavian artery, subclavian vein and vertebral artery within the tumor mass. During the removal of the spinal extension of the tumor, the neurosurgery team was involved to ensure safe resection from the spinal area. Ultimately, gross total resection (95%) of the mass was achieved including invaded ribs, providing direct access to the tumor with trap-door incision. Patient is in complete remission for 2 years.
Conclusion: Trap-door incision is an effective approach in managing complex and challenging tumor localizations, contributing to the patient’s favorable outcome.
Keywords: Trap-door incision, cervico-thoracic region, neuroblastoma
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