Preoperative Jugulofemoral Shunting in Complex Extended Thymectomy-Anesthetic Optimization for Invasive Thymoma

Malignant thymomas infiltrate adjacent blood vessels and mediastinal structures, posing challenges to surgical treatment. A 50-year-old man, who was diagnosed with type AB thymoma (Masaoka stage IVa) adhering to both superior vena cava (SVC) and bilateral innominate veins, underwent an extended total thymectomy with vascular reconstruction through a median sternotomy. Given the invasive nature of the large thymoma, which required SVC clamping and repair, a jugulofemoral shunt was introduced to improve hemostasis and minimize the risk of cerebral venous hypertension intraoperatively. This case highlights the successful application of preoperative venovenous shunting, emphasizing its role in preventing complications associated with SVC clamping.