Limited access to the vertebral bodies is provided by resection of a portion of rib and transverse process (costotransversectomy), an operation first described in 1894 by Ménard.8 Later, Capener2 extended this approach by resecting a longer segment of rib to allow anterolateral decompression of the spinal cord. He termed this operation “lateral rhacotomy.” In 1957, Nanson9 described an oblique approach to the lower cervical and upper thoracic vertebrae via a supraclavicular incision; his operation was designed to provide access to the upper thoracic sympathetic ganglia but also allows limited exposure of the upper thoracic vertebral bodies. In the same year, Cauchoix and Binet4 described a direct approach to the cervicothoracic region through a median sternotomy. Hodgson, et al.,6 used this approach in a small series of 10 cases, and noted an operative mortality of 40%. As a result, they advocated abandoning direct anterior exposures in favor of thoracotomy and resection of the third rib. Most surgical texts reiterate Hodgson's arguments, citing the morbidity associated with sternal resection and the difficulty in obtaining satisfactory fusion. More recently, Standefer et al.,12 described an operative technique for resection of a benign tumor involving the cervicothoracic junction by median sternotomy and fracture of the medial half of the clavicle.
Although tumors affecting the upper thoracic vertebrae are rare, we believe that a detailed description of an anterior approach to this region should be available to the neurosurgeon faced with this problem. We describe an operative exposure of the upper two thoracic vertebrae and analyze our results with this procedure.
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