The use of spinal angiography in the management of posterior mediastinal tumors: case series and review of the literature.
BACKGROUND
Resection 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.


METHODS
After 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.


RESULTS
One 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.


CONCLUSIONS
Preoperative 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.
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Andrew B
AB
Nordin
Sara C
SC
Fallon
Andrew
A
Jea
Eugene S
ES
Kim
D000792:Angiography / Q000379:methods*; D001158:Arteries / Q000033:anatomy & histology / Q000293:injuries; D002675:Child, Preschool; D004388:Dura Mater / Q000293:injuries; D005260:Female; D005729:Ganglioneuroma / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D064795:Intraoperative Neurophysiological Monitoring; D007511:Ischemia / Q000517:prevention & control; D062689:Lipoblastoma / Q000000981:diagnostic imaging* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008479:Mediastinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D020335:Paraparesis / Q000517:prevention & control; D010996:Pleural Effusion / Q000209:etiology; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D013116:Spinal Cord / Q000098:blood supply*; D013117:Spinal Cord Compression / Q000209:etiology; D013904:Thoracic Vertebrae; D013908:Thoracotomy
Adamkiewicz; Angiography; Lipoblastoma; Mediastinal; Neuroblastoma