Partial cervicosternotomy: a useful anterior surgical approach to the cervicothoracic junction

Access to the cervicothoracic junction, whether by lower anterior cervical or transthoracic approach, is particularly difficult. The authors propose partial cervicosternotomy which allows the T3-T4 disk to be reached satisfactorily in 50% of cases and in the remaining 50% allows direct anterior control of the upper two thirds of T3. The advantage of this approach is that it provides direct access to the cervicothoracic junction without leading at the same time to the reconstruction problems caused by the uni- or bilateral sternoclaviculotomies proposed until now. A detailed anatomical study of the arrangement of the intercostal vessels shows that this strictly median approach presents no risk to the medullary vessels thanks to the abundant anastomoses in this region. However, the use of this method may be limited if the aortic vessels have an anomalous origin. Pre-operative angiography is therefore necessary each time T3 must be reached. This approach has already been successfully used in tumor surgery for excision and reconstruction of lesions involving the cervicothoracic region.