Neurogenic Tumors of the Mediastinum

Sean C. Wightman, Joseph B. Shrager

Key Points

  • Neurogenic tumors in the adult are commonly of nerve sheath origin and the majority are benign.
  • Children and young adults are more prone to tumors of the autonomic ganglia, which are frequently malignant.
  • Nerve sheath tumors comprise one fifth of all mediastinal tumors. The majority of these are either schwannomas (also known as neurilemmomas) or neurofibromas.
  • Tumors arising from autonomic ganglia are classified into three histologic types: ganglioneuroma, ganglioneuroblastoma, and neuroblastoma.
  • von Recklinghausen’s neurofibromatosis is the only known predisposing factor for benign and malignant neurogenic tumors.
  • Surgery plays a dominant role in the treatment of for neurogenic tumors.
  • Intraspinal extension of neurogenic tumors must be recognized preoperatively and requires a combined posterior spinal and thoracic approach for safe resection.
  • Benign neurogenic tumors are good candidates for minimally invasive methods of resection (thoracoscopic [VATS] or robotic) whereas very large or malignant lesions should likely be approached via open exposures.

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