{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T07:12:29Z","timestamp":1780557149540,"version":"3.54.1"},"reference-count":12,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Cervicothoracic neuroblastomas (NBs) pose unique surgical challenges due to the complexity of the neurovascular structures located in the thoracic inlet. To date, two main techniques have been reported to completely remove these tumours in children: the trans-manubrial and the trap-door approaches. Herein, the authors propose a third new surgical approach that allows a complete exposure of the posterior costovertebral space starting from the retro-clavicular space: Cervico-Parasternal Thoracotomy (CPT). The incision is made along the anterior margin of the sternocleidomastoid muscle until its sternal insertion, and then the incision proceeds vertically following the ipsilateral parasternal line. The major pectoralis muscle is detached, and the clavicle and the ribs are disarticulated from their sternal insertions. Following an accurate isolation of the major subclavian blood vessels and the brachial plexus roots, the tumour is then completely exposed and resected by switching from a frontal to a lateral view of the costo-vertebral space. By adopting this technique, five cervicothoracic NBs were completely resected in a median operative time of 370 min (range: 230\u2013480 min). By proceeding in safety with the heart apart, neither vascular injuries nor nerve damages occurred, and all patients were safely discharged in a median postoperative time of 11 days (range: 7\u201314 days). At the last follow-up visit (median: 16 months, range: 13\u201321 months), all patients were alive and disease-free.<\/jats:p>","DOI":"10.3390\/children8030229","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T11:48:22Z","timestamp":1615981702000},"page":"229","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Cervico-Parasternal Thoracotomy (CPT): A New Surgical Approach for the Resection of Cervicothoracic Neuroblastomas"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7709-8937","authenticated-orcid":false,"given":"Giuseppe","family":"Martucciello","sequence":"first","affiliation":[{"name":"Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), University of Genoa, 16147 Genoa, Italy"},{"name":"Department of Paediatric Surgery, IRCCS Giannina Gaslini Children\u2019s Hospital, 16147 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Fati","sequence":"additional","affiliation":[{"name":"Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), University of Genoa, 16147 Genoa, Italy"},{"name":"Department of Paediatric Surgery, IRCCS Giannina Gaslini Children\u2019s Hospital, 16147 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Avanzini","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, IRCCS Giannina Gaslini Children\u2019s Hospital, 16147 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6679-5921","authenticated-orcid":false,"given":"Filippo","family":"Senes","sequence":"additional","affiliation":[{"name":"Reconstructive Surgery and Hand Surgery Unit, IRCCS Giannina Gaslini Children\u2019s Hospital, 16147 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3529-1437","authenticated-orcid":false,"given":"Irene","family":"Paraboschi","sequence":"additional","affiliation":[{"name":"Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), University of Genoa, 16147 Genoa, Italy"},{"name":"Department of Paediatric Surgery, IRCCS Giannina Gaslini Children\u2019s Hospital, 16147 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1016\/j.ijporl.2003.08.046","article-title":"Localized cervical neuroblastoma: Prevention of surgical complications","volume":"67","author":"Haddad","year":"2003","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1007\/s00383-020-04692-2","article-title":"Trapdoor anterior thoracotomy for cervicothoracic and apical thoracic neuroblastoma in children","volume":"36","author":"Chui","year":"2020","journal-title":"Pediatr. Surg. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/j.jpedsurg.2012.03.087","article-title":"The surgical approach for cervicothoracic masses in children","volume":"47","author":"Avanzini","year":"2012","journal-title":"J. Pediatr. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e26527","DOI":"10.1002\/pbc.26527","article-title":"Long-term results of the transmanubrial osteomuscular-sparing approach for pediatric tumors","volume":"64","author":"Irtan","year":"2017","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s00383-007-2056-x","article-title":"Navigating the thoracic inlet in children","volume":"24","author":"Jones","year":"2007","journal-title":"Pediatr. Surg. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1016\/j.jpedsurg.2013.03.061","article-title":"The use of the trapdoor incision for access to thoracic inlet pathology in children","volume":"48","author":"McMahon","year":"2013","journal-title":"J. Pediatr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1093\/ejcts\/ezr005","article-title":"Surgical outcome analysis of paediatric thoracic and cervical neuroblastoma","volume":"41","author":"Parikh","year":"2012","journal-title":"Eur. J. Cardio-Thoracic Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1016\/j.jpedsurg.2007.11.013","article-title":"Cervicothoracic neuroblastoma arising from the stellate ganglion in children: The use of muscle and bone sparing transmanubrial transcostal approach","volume":"43","author":"Pimpalwar","year":"2008","journal-title":"J. Pediatr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/0022-3468(95)90127-2","article-title":"Approach to cervicothoracic neuroblastomas via a trap-door incision","volume":"30","author":"Pranikoff","year":"1995","journal-title":"J. Pediatr. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s00383-013-3431-4","article-title":"Outcome and morbidity of surgical resection of primary cervical and cervicothoracic neuroblastoma in children: A comparative analysis","volume":"30","author":"Qureshi","year":"2013","journal-title":"Pediatr. Surg. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.surg.2005.07.029","article-title":"The transmanubrial approach: A new operative approach to cervicothoracic neuroblastoma in children","volume":"139","author":"Sauvat","year":"2006","journal-title":"Surgery"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.critrevonc.2016.10.001","article-title":"Neuroblastoma (Peripheral neuroblastic tumours)","volume":"107","author":"Luksch","year":"2016","journal-title":"Crit. Rev. 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