title: Postoperative paraplegia after resection of a giant posterior mediastinal tumour. Importance of the blood supply in the upper spinal cord.
abstract: A 10-cm diameter tumour was revealed in the left upper posterior mediastinum in a 15-year-old female. After exclusion of the possibility of a dumbbell tumour and confirmation of a ganglioneurinoma, an encapsulated, but vascularised tumour was removed via a left posterolateral thoracotomy from the level of the first-third costo-vertebral angle, without intraoperative complications. Following surgery, acute paraplegia was diagnosed, with a spinal cord lesion at the high thoracic level. Magnetic resonance imaging did not reveal any disorder in the spinal cord. In response to medical treatment, the patient's locomotor and sensation functions normalised within six months. On revising the preoperative computed tomography, we found dilated vessels passing through the tumour and the hypoplastic vertebral artery on the left side. This finding led us to suspect that the spinal cord circulation was partially supplied by the arteries passing through the tumour, which were clipped during surgery. Verification of the blood supply of the spinal cord is therefore highly recommended before resection of a giant tumour from the posterior mediastinum.
authors.affiliation: Department of Surgery, University of Szeged, Szeged, Hungary. jfurak@gmail.com
authors.forename: József
authors.initials: J
authors.lastname: Furák
authors.forename: Tibor
authors.initials: T
authors.lastname: Géczi
authors.forename: László
authors.initials: L
authors.lastname: Tiszlavicz
authors.forename: György
authors.initials: G
authors.lastname: Lázár
mesh_terms: D000293:Adolescent; D001706:Biopsy; D005260:Female; D005729:Ganglioneuroma / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008479:Mediastinal Neoplasms / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D009043:Motor Activity; D010264:Paraplegia / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D020127:Recovery of Function; D012039:Regional Blood Flow; D012677:Sensation; D013904:Thoracic Vertebrae / Q000098:blood supply*; D013908:Thoracotomy / Q000009:adverse effects*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000503:physiopathology*