The Annals of thoracic surgery
-
Median sternotomy has been the accepted approach for dealing with mediastinal tumors or bilateral pulmonary disease, but exposure to the lower lobes and to mediastinal tumors extensively involving a hemithorax is often limited. Based on the reported experience from double-lung transplantation, we explored the use of clamshell incisions for these difficult problems. From March 1991 to December 1993, we prospectively studied the utility of clamshell incisions in 90 patients for the following indications: bilateral pulmonary metastases (62 patients), primary lung carcinoma with mediastinal involvement (13 patients), primary tumors of the mediastinum (14 patients), and mesothelioma (1 patient). ⋯ There was one wound infection. There was no late sternal override and the cosmetic results were found to be excellent during a follow-up of 2 to 33 months. We conclude that clamshell incisions constitute an improved surgical approach for the management of bilateral pulmonary or combined pulmonary and mediastinal disease.
-
Removal of cerebrospinal fluid (CSF) has been proposed as a means of protecting the spinal cord against ischemic injury during thoracoabdominal aneurysm operations. We investigated the effect of altering CSF pressure (CSFP) on lumbar spinal cord blood flow (SCBF) in an experiment using dogs. The SCBF was measured before and after withdrawal of CSF in settings with and without thoracic aortic clamping. ⋯ Elevation of CSFP significantly reduced SCBF. Elevation of CSFP reduces SCBF, but lowering CSFP per se does not increase SCBF whether the thoracic aorta is occluded or not. This supports the notion that removal of CSF offers spinal cord protection only when CSFP is abnormally elevated.