Complete Resection of a Middle Mediastinal Malignant Peripheral Nerve Sheath Tumour via a Transmanubrial Osteomuscular Sparing Approach: A Case Report.

Malignant peripheral nerve sheath tumour (MPNST) is a rare soft-tissue sarcoma, and mediastinal involvement-particularly in the middle mediastinum-is exceedingly uncommon. Complete resection is crucial for favourable outcomes, as MPNST is generally resistant to chemotherapy and radiotherapy. We report a case of a middle mediastinal MPNST completely resected using a transmanubrial osteomuscular sparing approach (TMA). A 35-year-old man with neurofibromatosis type 1 presented with an enlarging 6.8-cm middle mediastinal mass suspected to be a malignant neurogenic tumour. Although initially considered unresectable due to its proximity to major mediastinal structures, surgical exploration using a TMA enabled complete resection. The tumour originated from the right vagus nerve, and histopathological examination confirmed MPNST with negative margins. This case highlights the importance of not deeming tumours unresectable based solely on preoperative imaging, but rather evaluating the potential for complete resection through intraoperative findings in selected cases.