Interest of Preoperative Arteriography to Identify the Adamkiewicz Artery Before Surgery for Basi-thoracic Neuroblastic Tumors

Neuroblastic tumors (NBTs) develop from neural crest cells that give rise to the sympathetic nervous system. They include neuroblastomas, ganglioneuroblastomas, and ganglioneuromas. They represent approximately 10% of solid tumors in children under 15 years of age. In 15 to 20% of cases, NBTs are located in the thoracic region. These paravertebral tumors have an extracanal component and some also have an intraspinal component (dumbbell tumors) that can cause spinal cord compression. Surgery for these tumors also exposes the patient to neurological complications. In the thorax, the basi-thoracic location (T9-T12) may be particularly at risk due to the presence of the artery of Adamkiewicz (AKA), which supplies blood to the spinal cord; damage to this artery can result in spinal cord ischemia. To avoid this scenario, some teams recommend performing spinal cord arteriography to identify AKA. However, many centers do not perform arteriography and do not report more postoperative complications. Currently, there is no consensus on the indications for performing preoperative spinal arteriography in patients undergoing surgery for basi-thoracic NBT. This study evaluates the practice in France of preoperative arteriography to identify the AKA among patients undergoing surgery for basi-thoracic neuroblastic tumors and analyzes the incidence of postoperative neurological complications in these patients.

Sex

All

Maximum age

18 Years

Inclusion Criteria:

1. Patients undergoing surgery for a neuroblastic tumor (neuroblastoma, ganglioneuroblastoma, ganglioneuroma)
2. Basithoracic location between T8 and L1
3. With or without intraspinal component
4. Treated in a pediatric surgery department in France
5. Between 2005 and 2024
6. Adult patients or holders of parental authority of minor patients informed and not opposed to the use of data for the study

Exclusion Criteria:

1\. Post-operative follow-up of less than 6 months

• BACKGROUNDLindeire S, Hauser JM. Anatomy, Back, Artery of Adamkiewicz. 2025 Mar 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK532971/ PMID 30422566
• BACKGROUNDNordin AB, Fallon SC, Jea A, Kim ES. The use of spinal angiography in the management of posterior mediastinal tumors: case series and review of the literature. J Pediatr Surg. 2013 Sep;48(9):1871-7. doi: 10.1016/j.jpedsurg.2013.04.029. PMID 24074660
• BACKGROUNDSchmidt A, Hempel JM, Ellerkamp V, Warmann SW, Ernemann U, Fuchs J. The Relevance of Preoperative Identification of the Adamkiewicz Artery in Posterior Mediastinal Pediatric Tumors. Ann Surg Oncol. 2022 Jan;29(1):493-499. doi: 10.1245/s10434-021-10381-8. Epub 2021 Jul 31. PMID 34331163
• BACKGROUNDBosmia AN, Hogan E, Loukas M, Tubbs RS, Cohen-Gadol AA. Blood supply to the human spinal cord: part I. Anatomy and hemodynamics. Clin Anat. 2015 Jan;28(1):52-64. doi: 10.1002/ca.22281. Epub 2013 Jun 27. PMID 23813725
• BACKGROUNDDe Bernardi B, Gambini C, Haupt R, Granata C, Rizzo A, Conte M, Tonini GP, Bianchi M, Giuliano M, Luksch R, Prete A, Viscardi E, Garaventa A, Sementa AR, Bruzzi P, Angelini P. Retrospective study of childhood ganglioneuroma. J Clin Oncol. 2008 Apr 1;26(10):1710-6. doi: 10.1200/JCO.2006.08.8799. PMID 18375900
• BACKGROUNDFurak J, Geczi T, Tiszlavicz L, Lazar G. Postoperative paraplegia after resection of a giant posterior mediastinal tumour. Importance of the blood supply in the upper spinal cord. Interact Cardiovasc Thorac Surg. 2011 May;12(5):855-6. doi: 10.1510/icvts.2010.257105. Epub 2011 Feb 8. PMID 21303870
• BACKGROUNDBoglino C, Martins AG, Ciprandi G, Sousinha M, Inserra A. Spinal cord vascular injuries following surgery of advanced thoracic neuroblastoma: an unusual catastrophic complication. Med Pediatr Oncol. 1999 May;32(5):349-52. doi: 10.1002/(sici)1096-911x(199905)32:53.0.co;2-p.