The Relevance of Preoperative Identification of the Adamkiewicz Artery in Posterior Mediastinal Pediatric Tumors

Abstract Background Injury to the artery of Adamkiewicz (AKA) during surgery may lead to spinal cord ischemia and severe neurologic complications. Posterior mediastinal tumors may be adjacent to AKA, but data on preoperative visualization of AKA in children are rare. This study analyzed the importance of identifying the AKA preoperatively by spinal digital subtraction angiography (DSA) in children with posterior mediastinal tumors for therapeutic procedure. Methods Between 2002 and 2021, 36 children with posterior mediastinal tumors were evaluated for surgery at the authors’ clinic. In 10 children with left-sided or bilateral tumor located at vertebral levels T8 to L1, spinal DSA was performed during preoperative workup to assess AKA. The patient and tumor characteristics as well as the diagnostic and therapeutic procedures were analyzed. Results The median age of the 10 children at examination was 69 months (range, 16–217 months). Three of the children were younger than 2 years. The tumor entities were neuroblastoma, ganglioneuroblastoma, ganglioneuroma, local relapse of a hepatocellular carcinoma, and neurofibroma. The AKA was identified in all cases, and proximity to the tumor was detected in four patients, three of whom had their planned surgery changed to irradiation. No complications occurred during spinal DSA or surgery. Conclusions In posterior mediastinal pediatric tumors, spinal DSA is a safe and reliable method for preoperative visualization of the AKA. It can show proximity to the tumor and guide the local therapy, thereby avoiding critical intra- and postoperative situations.

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Artery of Adamkiewicz and the clinical repercussion of its lesion in thoracoabdominal surgeries: a systematic review

Brazilian Journal of Case Reports ◽

10.52600/2763-583x.bjcr.2021.1.4.9-21 ◽

2021 ◽

Vol 1 (4) ◽

pp. 9-21

Author(s):

Idna Lara Goes de Sena ◽

Maria Regina Cardoso Linhares Oliveira Lima ◽

Lia de Oliveira Jereissati ◽

Rafaella Iughetti da Costa ◽

Victor Oliveira Araújo ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injuries ◽

Spinal Cord Ischemia ◽

Three Dimensional ◽

Clinical Importance ◽

Dimensional Network ◽

Adamkiewicz Artery ◽

Artery Of Adamkiewicz ◽

Pass Through ◽

Preoperative Procedure

The knowledge of the spinal cord irrigation is important for the therapeutic planning of aortic pathologies; however, its vasculature is complex due to the caliber of its arteries that pass through a three-dimensional network with great anatomical variability. Its clinical importance is evidenced during the preoperative procedure of thoracic and thoracoabdominal aortic surgeries, because its identification is essential for the prevention of spinal cord injuries. This study consists of a literature review, in which searches were conducted in the databases - Bireme, Science Direct, Pubmed and Lilacs. Articles published between 1999 and 2020, written in English, Portuguese or Spanish, were selected. The search was conducted using the descriptors Anatomy, Spinal Cord Irrigation and Spinal Cord Ischemia. The Adamkiewicz artery is the main artery responsible for the arterial supply to the lower part of the spinal cord. Thus, paraplegia is a complication of this type of surgical approach resulting from ischemic suffering of the spinal cord during the process. Therefore, further study on these factors should be encouraged, because the preservation of this vessel is relevant given the search for protection of the spinal cord and the maintenance of its functions in this type of procedure.

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Intractable Posterior Epistaxis due to a Spontaneous Low-Flow Carotid-Cavernous Sinus Fistula: A Case Report and a Review of the Literature

Case Reports in Otolaryngology ◽

10.1155/2015/739019 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

A. Giotakis ◽

F. Kral ◽

H. Riechelmann ◽

M. Freund

Keyword(s):

Case Report ◽

Cavernous Sinus ◽

Gold Standard ◽

State Of The Art ◽

Low Flow ◽

Digital Subtraction ◽

Review Of The Literature ◽

Therapeutic Procedures ◽

Carotid Cavernous Sinus Fistula

We report a case of a 90-year-old patient with intractable posterior epistaxis presenting as the only symptom of a nontraumatic low-flow carotid-cavernous sinus fistula. Purpose of this case report is to introduce low-flow carotid-cavernous sinus fistula in the differential diagnosis of intractable posterior epistaxis. We provide a literature review for the sequence of actions for the confrontation of posterior epistaxis. We also emphasize the significance of the radiological diagnostic and therapeutic procedures in the management of posterior epistaxis due to pathology of the cavernous sinus. The gold-standard diagnostic procedure of carotid-cavernous sinus fistula is digital subtraction angiography (DSA). DSA with coils is also the state-of-the-art therapy. By failure of DSA, neurosurgery or stereotactic radiosurgery (SRS) may be used as alternatives. SRS may also be used as enhancement procedure of the DSA. Considering the prognosis of a successfully closed carotid-cavernous sinus fistula, recanalization occurs only in a minority of patients. Close follow-up is advised.

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