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One-stage resection for massive cervicomediastinal hygroma
Insights
Cervicomediastinal cystic hygromas can cause infant respiratory distress. Surgical resection via a sternum-splitting incision offers a curative and well-tolerated treatment option for these large masses.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Medical Imaging
Background:
- Cervicomediastinal cystic hygromas are a significant cause of respiratory distress in infants.
- These congenital malformations require effective management strategies.
Purpose of the Study:
- To describe the management and outcomes of infants and children with large cervicomediastinal cystic hygromas.
- To evaluate the efficacy of a one-stage surgical resection approach.
Main Methods:
- Review of ten pediatric patients (newborn to 4 years) with cervicomediastinal cystic hygromas.
- Diagnostic workup included neck examination, ultrasonography, and chest X-ray.
- Surgical management involved complete resection via an inverted hockey stick (sternum-splitting) incision.
Main Results:
- Eight of ten patients presented with respiratory distress.
- The intrathoracic component was unsuspected in four infants prior to operation.
- Nine out of ten patients survived, with no recurrences during follow-up (9 months to 10 years).
- Three patients developed Horner's syndrome postoperatively.
Conclusions:
- One-stage resection using a sternum-splitting incision is a well-tolerated and curative treatment for cervicomediastinal cystic hygromas.
- This surgical approach is superior to other treatment methods for these complex pediatric masses.
Abstract:
Cervicomediastinal cystic hygroma has long been recognized as a serious cause of respiratory distress in infancy. This report describes the management of ten infants and children with large cervicomediastinal hygromas. Ages ranged from the newborn to 4 years (average 18.4 months). Six were boys and four were girls. Eight presented with respiratory distress. Neck examination, ultrasonography, and chest x-ray examination were usually diagnostic. In four infants the intrathoracic component was initially clinically unsuspected. The neck lesion descends into the chest between the subclavian vein and artery. At operation the mass was dissected off the pericardium; phrenic, vagus, and recurrent laryngeal nerves; esophagus; aortic arch; and subclavian vessels. Complete resection was possible in each case. Nine of ten patients survived. Death occurred in a newborn with bilateral tumor and pulmonary hypoplasia. Three patients developed Horner's syndrome. There were no recurrences (follow-up 9 months to 10 years). These data indicate that a one-stage resection using an inverted hockey stick (sternum-splitting) incision is well tolerated, curative, and superior to other methods of treatment in infants with cervicomediastinal cystic hygroma.