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Preoperative spinal angiography decreases risk of spinal ischemia in pediatric posterior thoracic tumor resection

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Abstract

Purpose

Resection of pediatric posterior thoracic tumors (PTTs) can be complicated by Artery of Adamkiewicz (AKA) injury. Post-op spinal ischemia occurs in approx. 3.2% of patients, typically due to iatrogenic vascular injury. Pre-op angiography (PSA) may help to avoid this complication. Herein, we aim to evaluate outcomes after initiation of routine PSA prior to PTT resection.

Methods

A single-institution retrospective review identified 25 children (< 18 years) treated for PTTs from 2009 to 2021. PTTs included: posterior mediastinum, paraspinal thorax and posterior chest wall tumors. PSA patients were compared to those without pre-operative angiography (NA). Demographics, perioperative and long-term outcomes and event-free survival (EFS) were assessed.

Results

Prior to 2012, eleven patients were treated without PSA. However, the last developed post-operative paraplegia secondary to spinal ischemia. Since this event, PSA has become routine for all PTTs (n = 14) identifying six AKAs and nine accessory spinal arteries. Resection was performed in ten (90.1%) NA patients and eight (57.1%) PSA patients. Based on PSA findings, resection was not offered to six patients and planned partial resection was performed in three patients. Five PSA patients required radiation therapy for local control vs two NA patients. There were no differences in recurrence or overall EFS.

Conclusion

PSA aids in identifying patients with high-risk thoracic vascular anatomy and may prevent risk of post-operative paraplegia associated with PTT resection.

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Abbreviations

PTT:

Posterior thoracic tumor

AKA:

Artery of Adamkiewicz

PSA:

Preoperative spinal angiography

NA:

No angiography

ASA:

Anterior spinal artery

EBL:

Estimated blood loss

RT:

Radiation therapy

EFS:

Event-free survival

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, 1935 Medical District Dr. Suite D2000, Dallas, TX, 75235, USA

    Rachael A. Clark, Jillian C. Jacobson & Joseph T. Murphy

Authors
  1. Rachael A. Clark
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  2. Jillian C. Jacobson
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  3. Joseph T. Murphy
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Contributions

RAC and JTM designed and conceptualized the study. Data acquisition was performed by RAC and JCJ. Data analysis and interpretation was performed by all authors. RAC prepared all figures. RAC and JCJ prepared all tables. Drafting of the manuscript and critical revision was performed by all authors.

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Correspondence to Joseph T. Murphy.

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The authors declare no conflict of interest.

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Supplementary Information

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383_2022_5174_MOESM1_ESM.docx

Supplemental Table 1 Characteristics, findings and management of patients who underwent routine Preoperative Spinal Angiography. ASA, anterior spinal artery; AKA, artery of Adamkiewicz; OSH, outside hospital; GTR, gross-total resection; VATS, video-assisted thoracoscopic surgery. Supplementary file1 (DOCX 18 KB)

383_2022_5174_MOESM2_ESM.docx

Supplemental Table 2 Disease classification. * Desmoid tumor (2), osteochondroma (1), ganglioneuroma (2) and ganglioneuroblastomas (2). NA, no pre-operative angiography; PSA, pre-operative angiography. Supplementary file2 (DOCX 15 KB)

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Clark, R.A., Jacobson, J.C. & Murphy, J.T. Preoperative spinal angiography decreases risk of spinal ischemia in pediatric posterior thoracic tumor resection. Pediatr Surg Int 38, 1427–1434 (2022). https://doi.org/10.1007/s00383-022-05174-3

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  • DOI: https://doi.org/10.1007/s00383-022-05174-3

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