Manubrial split provides adequate exposure for mediastinal exploration for parathyroid adenoma
Edward Lake, James Kirkby-Bott, Fawzia Imtiaz, James Jackson & Fausto Palazzo
Introduction: The traditional approach to mediastinal ectopic parathyroid adenomas has been through a median sternotomy. With improved localization techniques it has become possible to use less invasive approaches to access the mediastinum. We present our recent experience of three cases of mediastinal parathyroid adenomas successfully treated using a manubriotomy approach which provides good access to the superior and anterior mediastinum.
Method: All patients had pre-operative localization with sestamibi and USS. Where MIBI highlighted a mediastinal gland SPECT MIBI and contrast CT imaging were used to confirm the adenomas position in the superior/anterior mediastinum.
Results: The diagnosis of primary hyperparathyroidism (HPT) was established using standard departmental protocols. In all three cases the glands were seen on MIBI and CT and localised to a mediastinal compartment. At surgery removal of the thymus and all other fatty tissue in the superior/anterior mediastinum was needed. Frozen section was used to confirm the presence of parathyroid tissue. In all cases parathyroid tissue was demonstrated on permanent section histology and serum calcium and PTH levels promptly returned to within the normal range. All patients made swift recovery with little analgesic requirement.
Conclusion: Although case reports of mediastinoscopic and thoracoscopic removal exist careful and meticulous dissection of the mediastinal compartments is needed to ensure removal of all parathyroid tissue. Traditionally this has been performed using a median sternotomy, but manubriotomy appears to provide a safe curative approach with a short recovery.