Spinal cord vascular injuries following surgery of advanced thoracic neuroblastoma: An unusual catastrophic complication

Boglino, C.; Martins, António Gentil; Ciprandi, G; Sousinha, Màrio; Inserra, Alessandro

doi:10.1002/(sici)1096-911x(199905)32:5<349::aid-mpo7>3.0.co;2-p

Cited by 37 publications

(16 citation statements)

References 13 publications

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“…Umbilical artery catheters can cause spinal cord infarction in neonates [33][34][35][36], usually due to disruption of the artery of Ademkiewitcz, a major artery of the thoracic cord. Damage to this artery with resulting spinal cord infarction has also been reported in one child during the removal of a thoracic neuroblastoma [37]. Surgery on the aorta is a known cause of spinal cord infarction in adults [38]; children undergo aortic operations less frequently, and they are usually confined to the arch.…”

Section: Causes Of Spinal Cord Infarction In Childrenmentioning

confidence: 99%

Ischemic Spinal Cord Infarction in Children Without Vertebral Fracture

Nance

Golomb

2007

Pediatric Neurology

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Spinal cord infarction in children is a rare condition which is becoming more widely recognized. There are few reports in the pediatric literature characterizing etiology, diagnosis, treament and prognosis. The risk factors for pediatric ischemic spinal cord infarction include obstruction of blood flow associated with cardiovascular compromise or malformation, iatrogenic or traumatic vascular inujury, cerebellar herniation, thrombotic or embolic disease, infection, and vasculitis. In many children the cause of spinal cord ischemia in the absence of vertebral fracture is unknown. Imaging diagnosis of spinal cord ischemia is often difficult due to the small transverse area of the cord, cerebrospinal fluid artifact and inadequate resolution of MRI. Physical therapy is the most important treatment option. The prognosis is dependent on the level of spinal cord damage, early identification and reversal of ischemia, and follow-up with intensive physical therapy and medical support. In addition to summarizing the literature regarding spinal cord infarction in children without vertebral fracture, this review article adds two cases to the literature which highlight the difficulties and controversies in the management of this condition.

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Section: Causes Of Spinal Cord Infarction In Childrenmentioning

confidence: 99%

Ischemic Spinal Cord Infarction in Children Without Vertebral Fracture

Nance

Golomb

2007

Pediatric Neurology

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“…However, the optimal management of neuroblastoma‐induced SCC is still discussed. For example, while neurosurgery can achieve immediate decompression, this can lead to collateral tissue alteration 2 . Another alternative is chemotherapy that can reduce the volume of an intraspinal tumour within a few days.…”

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confidence: 99%

Short‐ and long‐term outcome of patients with symptoms of spinal cord compression by neuroblastoma

Simon

Niemann

Hero

et al. 2012

Develop Med Child Neuro

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Aim Prospective trials on neuroblastoma‐induced myelopathy are lacking. Therefore, we retrospectively analysed patients in four national neuroblastoma trials. Method Neuroblastoma patients diagnosed between August 1989 and December 2008 were included. Clinical and molecular data were available in the national trials database. Additional details on neurological findings, treatment, and outcome were collected using a questionnaire. Results Among 2603 patients, 122 (61 males and 61 females) had symptoms of spinal cord compression (SCC), and 99 of these were included in the final long‐term analysis. The survival of patients with symptoms of SCC was better than that of patients without symptoms. Patients first presented with lower extremity motor impairment (95%), impaired cutaneous sensibility (58%), neuropathic pain (56%), bladder dysfunction (44%), and/or constipation (34%). Symptoms improved after first‐line neurosurgery in 36 out of 52 patients and after first line chemotherapy in 30 out of 47 patients (p=0.77). After a median observation time of 8 years 1 month (range 1mo–19y 6mo), 71 out of 99 patients still had residual impairments: motor impairment (43%), scoliosis (31%), impaired bladder function (26%), constipation (19%), impaired cutaneous sensibility (17%), growth delay (14%), and neuropathic pain (5%). The initial treatment had no clear impact on the frequency of late effects. Interpretation This retrospective analysis showed no clear advantage of either first‐line neurosurgery or chemotherapy and that most patients still exhibit residual symptoms and require specialized care.

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“…For these tumors to cross-occupy both thoracic and abdominal cavities, the tumors occupied both paradiaphragmatic regions with diaphragmatic infiltration. They would typically involve the lower mediastinum infiltrating the costovertebral junction between T9 and T12 associated with the increased risk of anterior spinal artery syndrome following the damage or obstruction of the Adamkiewicz artery,7 as occurred in one of our patients. The above three features of dual compartment infiltration, diaphragmatic infiltration, and T9–T12 costovertebral involvement were IDRFs consistently found in this group of tumors.…”

Section: Discussionmentioning

confidence: 88%

Management of thoracoabdominal neuroblastoma: a 13-year experience

Chui¹,

Lee

2019

World Jnl Ped Surgery

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BackgroundThoracoabdominal neuroblastoma is a unique surgical challenge. We reviewed our experience focusing on disease patterns and corresponding surgical approaches.MethodsAmong 310 patients in our neuroblastoma database, 30 (9.7%) had thoracoabdominal neuroblastoma. Patients’ clinical charts were reviewed and analyzed. Two disease patterns were identified: solitary thoracoabdominal tumor (group A, n=15) and multifocal tumors in thorax and abdomen (group B, n=15). Operative approaches were categorized based on routes of surgical access.ResultsThirty patients with average age of 4.1 (range 0.8–12.8) years were studied. All received preoperative chemotherapy. Among 15 group A patients, four were stage 3 intermediate risk (IR) and 11 were stage 4 high risk (HR). Surgical approaches included single-incision thoracoabdominal approach (n=10), laparotomy-cum-transdiaphragmatic approach (n=3), and laparotomy-cum-thoracotomy approach (n=2). One patient had 10% residual disease and the rest achieved gross total resection. Postoperative complications included chylous ascites (n=3), intestinal obstruction (n=3), pneumonia (n=1), spinal cord infarction (n=1) scoliosis (n=2) and thoracoabdominal nerves palsy (n=3). Among 15 group B patients, all were stage 4 with five IR and 10 HR. Thoracic components were found in the posterior mediastinum (n=7), superior mediastinum (n=4), middle mediastinum (n=1), parietal pleura (n=3) and lungs (n=3). Surgical approaches included multi-incision laparotomy-cum-thoracotomy (n=14) and laparotomy-cum-transdiaphragmatic approach (n=1). Gross total resection was achieved in all surgeries. Postoperative complications included chylous ascites (n=3). Overall, all nine IR patients survived without evidence of disease and 9 (42.8%) HR patients died of disease. There was no perioperative mortality.ConclusionSurgical resection of thoracoabdominal neuroblastoma is feasible and safe. Despite its complexity, thoracoabdominal neuroblastoma has comparable treatment outcomes when compared with single-compartmental disease.

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Spinal cord vascular injuries following surgery of advanced thoracic neuroblastoma: An unusual catastrophic complication

Cited by 37 publications

References 13 publications

Ischemic Spinal Cord Infarction in Children Without Vertebral Fracture

Ischemic Spinal Cord Infarction in Children Without Vertebral Fracture

Short‐ and long‐term outcome of patients with symptoms of spinal cord compression by neuroblastoma

Management of thoracoabdominal neuroblastoma: a 13-year experience

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