[Mediastinoscopy in children]

This technique enables the exploration of the mediastinum by the cervical way, but remains an unfrequent examination in children. Among almost 1000 mediastinoscopies made by the authors, the indication concerned only 20 children aged less than 17. Made in a prognostical purpose in most of the cases (16 patients) it gave the diagnosis 14 times. In four cases the mediastinoscopy was carried out as a prognosis during a pre-therapeutics of some hematosarcomas. This method requires a general anaesthesia with intubation, but doesn't differ much from the technic for adults. Besides the supra-sternal way leading to the axial mediastinum (Carlens's technic) other ways are used, particularly the anterior mediastinoscopy--exploring the thymic lodge--and the antero-lateral way through an intercostal space. The mediastinoscope enable the visual control of the lesions, completed with biopsies of the tissues for an histological examination and puncture with a needle for the cytology study. The diagnosis was made in 90% of the cases, sometimes after repeat mediastinoscopy. The failures are due most often to an incertitude in the interpretation of the samples than a badly directed biopsy. There was no surgical incident in our serie. The general morbidity of the examination is 1,5% and the mortality is 0,1% according to the authors. But two anesthetic incidents were observed in children with malignant lymphomas and required the use of reanimation technics. The mediastinoscopy is useful in the tumors of the thymus (10 times), the tumors of the lateral mediastinum (8 times) an hematosarcomas or Hodgkin's disease.