The use of spinal angiography in the management of posterior mediastinal tumors: Case series and review of the literature |
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Authors: | Andrew B. Nordin Sara C. Fallon Andrew Jea Eugene S. Kim |
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Affiliation: | 1. Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children''s Hospital, Houston, TX, USA;2. Pediatric Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children''s Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA |
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Abstract: |
IntroductionResection of inferiorly located posterior mediastinal tumors can be complicated by their proximity to the artery of Adamkiewicz (AKA). Although uncommon, intraoperative injury to the AKA may result in paraparesis or paralysis secondary to spinal cord ischemia. The use of preoperative spinal angiography may serve as a useful adjunct to the surgeon in guiding extent of resection of the tumor to avoid injury to this critical artery.MethodsAfter IRB approval (H-31712), three patients, from 2008 to 2011, with lower posterior mediastinal tumors were identified. Their charts were reviewed for information concerning preoperative imaging, operative details, and postoperative neurologic complications. The literature regarding imaging of the AKA, cases of injury in pediatric patients, and recommendations for treatment after its injury were reviewed.ResultsOne patient, who did not have preoperative spinal angiography, developed transient paresis lasting 6 weeks after posterior mediastinal tumor resection. Two patients underwent preoperative spinal angiography with successful localization of the AKA. In both cases, the patients subsequently underwent posterior mediastinal tumor resection without injury to the artery and without postoperative neurologic sequelae.ConclusionsPreoperative spinal angiography may serve as a useful adjunct in the evaluation of children with inferior posterior mediastinal tumors in order to delineate the relationship of the artery of Adamkiewicz to the tumor for the purpose of guiding surgical resection. |
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Keywords: | Mediastinal Angiography Neuroblastoma Lipoblastoma Adamkiewicz |
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