Bilateral Phrenic Nerve Reconstruction With Intercostal Nerve Grafts After Thymic Carcinoma Resection

A 51-year-old man with thymic carcinoma presented with superior vena cava syndrome and right diaphragmatic paralysis. He underwent extended thymectomy with major venous reconstruction; the right phrenic nerve was resected with diaphragmatic plication, whereas the left phrenic nerve was sacrificed intraoperatively without plication. Postoperatively, ventilator weaning failed as a result of bilateral phrenic nerve palsy and recurrent superior vena cava syndrome. Emergency reoperation included bilateral phrenic nerve reconstruction with intercostal nerve grafts and revision of venous reconstruction. The patient was weaned from ventilation on day 22, discharged on day 42, and showed objective diaphragmatic recovery at 6 months.