Supraclavicular resection of an upper thoracic neurofibroma with intrathoracic extension in an adolescent: a case report

Neurofibromas are benign peripheral nerve sheath tumors commonly associated with neurofibromatosis type 1 (NF1). Upper thoracic paraspinal neurofibromas with intrathoracic extension are rare in pediatric patients and pose significant surgical challenges because of the complex anatomy of the cervicothoracic junction. A 13-year-old male patient presented with a gradually enlarging right supraclavicular mass and intermittent discomfort. Physical examination revealed six or more café-au-lait macules, raising suspicion for an evolving NF1 phenotype; however, the patient did not fulfill the diagnostic criteria for NF1 at presentation. Radiological evaluation demonstrated a well-circumscribed paraspinal mass measuring approximately 40.9 mm and extending from T2 to T4, with right-sided intrathoracic extension and compression of the right lung apex. There was no neural foraminal or spinal canal involvement, vertebral destruction, or encasement of major neurovascular structures. Based on these anatomical and radiological characteristics, the lesion was resected through a stand-alone supraclavicular approach without thoracotomy or posterior spinal exposure. No identifiable spinal nerve root or major branch of the brachial plexus was involved or sacrificed. Gross total resection was achieved without intraoperative complications. Histopathological examination confirmed a benign localized neurofibroma without evidence of malignant transformation. Postoperative imaging confirmed complete resection, and the patient remained neurologically intact, with no residual or recurrent lesion during 12 months of follow-up. This case demonstrates the feasibility of complete resection of a pediatric upper thoracic paraspinal neurofibroma with intrathoracic extension and lung apex compression through a purely supraclavicular corridor. In carefully selected patients with a well-circumscribed lesion and no foraminal, spinal canal, vertebral, or major neurovascular involvement, this approach may avoid the morbidity associated with thoracotomy or posterior exposure.