Two-stage approach in the management of thoracic neuroenteric cyst with spinal extension: thoracoscopic excision following dorsal laminectomy.

[congenital diaphragmatic hernia]

Neuroenteric cysts (NC ) are rare pathologies and localized generally in posterior mediastinum or abdomen where they may extend to spinal canal through a vertebral defect . Isolated spinal lesions require dorsal /ventral laminectomy and thoracic ones thoracotomy or thoracoscopy . Posterolateral approach via thoracotomy is generally performed for lesions with both thoracic and spinal components . Minimal invasive excision of a thoracic NC with spinal extension in an infant is presented herein .A term female newborn with an antenatal (26 th week ) diagnosis of congenital diaphragmatic hernia (CDH ) was admitted . On physical examination , she was normal except mild dyspnea and CDH were excluded on radiogram . Left parenchymal opacity necessitated thorax tomography that revealed lobulated cystic lesion (6 × 3 .5 × 4 .5 cm ) in posterior mediastinum . MRI showed intraspinal extension of the lesion through a hemivertebrae (6 th ). Two -stage procedure was planned for suspected neuroenteric cyst . First , intraspinal component was excised with dorsal laminectomy and the connection was closed . Then , the thoracic component was excised thoracoscopically . Histopathological evaluation confirmed the diagnosis . Total parenteral nutrition and high dose somatostatin analog was needed due to transient left chylothorax on postoperative course . She was well and symptom-free in postoperative period .Neuroenteric cysts may lead to misdiagnoses in antenatal period . MRI is critical to show spinal and vertebral pathologies in suspected cases . Thoracoscopy may safely be performed for thoracic lesions with spinal extension in two -stage approach following closure of the connection and excision of the spinal component .