It is difficult to determine surgical approaches for treating a tumor arising at the thoracic outlet. Here we report a case of benign schwannoma arising at the thoracic apex, in which both pleural and cervical approaches were adopted. Chest radiographs of a 58-year-old male at the medical checkup in 2009 showed a tumor shadow in the right apical region that was increasing since 2003. He had no symptoms. Computed tomography(CT)and magnetic resonance imaging (MRI) showed a 35-mm tumor, which had a smooth surface and was suspected as a neurogenic tumor arising at the right thoracic outlet. Surgery for this tumor was performed by the thoracoscopic approach with a mini thoracotomy through the 3 intercostal space 1. The tumor was suspected to arise from the brachial plexus, and was not able to be enucleated. Then we made a cervical incision and the tumor was resected safely using a pleural approach together with a cervical approach. The pathological finding was benign shwannoma. Mild ulnar nerve palsy was observed in the patient after surgery, which gradually improved within 3 years.
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