Mediastinum Surgery

Mediastinum is a cavity in rib cage between lungs, heart and trachea. Surgical conditions in mediastinum can be roughly classified as:

• Mediastinitis: Mediastinitis is the inflammation of mediastinum. It usually manifests itself with abscess. Conditions damaging esophagus by an infection developing therein may develop as a complication as a result of an oral infection spreading downwards or following some surgeries, thereby worsening the general condition of the patient. Immediate intervention is required in this case. Abscess in mediastinum is discharged by intervention through just above the breastbone called sternum and through the rib cage.
• Cysts: Cyst is a term used for thick-walled formations filled with fluid. Most of the mediastinal cysts are congenital and grows progressively. Although they are usually benign, they must be removed due to their pressure on surrounding tissues. Whole cyst must be removed by sternotomy (by incision in the sternum) or through the chest cavity (Thoracotomy or VATS). Treatment is completed with the removal of the whole cyst
• Mediastinal tumors: Various benign and malignant tumors originating from mediastinal structures may be seen. Surgery, radiotherapy or chemotherapy can be performed depending on characteristics of the tumor.
• Thymus surgery: Thymus is a gland in the form of H found in anterior mediastinum and extending into pericardium – a gland positioned on trachea and heart. Benign and malignant tumors originating from this gland (thymoma and thymic carcinoma) are the most frequent tumors in anterior mediastinum. These tumors are staged like tumors in other sites. Surgery is performed in early stages. Radiotherapy or chemotherapy is also applied as supportive treatment. Operation is usually performed via “Sternotomy”. Breastbone called as sternum is vertically cut in a straight line with special saws under anesthesia and split in half. Anterior mediastinum appears with this procedure. Thymus gland is removed together with its tumorous tissue and sites where tumor has spread. It is important to remove the whole tumor. If it cannot be completely removed, radiotherapy and/or chemotherapy and additional treatments are performed after the surgery.

Apart from these, in the disease called “Myasthenia Gravis” which is a neurological disorder manifesting itself with fatigue and weakness in muscles, Thymus gland may need to be removed despite being non-tumorous. These patients heal at the rate of 30-80% after the removal of thymus gland. Thymus can be removed both with serotomy and closed surgery called VATS.