Preoperative Identification of Adamkiewicz Artery in Pediatric Posterior Thoracic Tumors: Fact or Fiction? A Systematic Review From the International Society of Pediatric Surgical Oncology (IPSO)

Abstract

Background and aims: We aimed to review current literature on the impact of Preoperative Identification (POI) of the Adamkiewicz Artery (AKA) in solid pediatric Posterior Thoracic Tumors (PTT), comprising a spectrum of neuroblastic tumors and neuroblastoma, with particular focus on Complete Macroscopic Excision (CME) and Neurologic Complications/Sequelae (NCS). Methods: A systematic review in accordance with PRISMA guidelines was undertaken. The study included reports on pediatric patients providing available data on POI of the AKA in PTT. Results: Among 838 records screened, 33 full-texts underwent evaluation, and 8 papers were included. Among 49 tumors (N = 49 patients), 30 were neuroectodermic tumors. Spinal angiography (SA) was undertaken in four studies for 32 (65%) patients. No SA-related morbidity was recorded. Otherwise, a combination of CT and/or MRI imaging was described. The lack of detailed reporting on CT/MRI imaging, hindered a feasible detailed comparative analysis among non-SA imaging modality techniques. The overall success rate of AKA POI was 65%, 71% with SA and 33% with non-SA studies. CME was achieved in 73% of SA and 80% non-SA groups. Overall, 5 children experienced NCS, 60% of those who had dumbbell tumors. All NCS occurred in patients without successful POI of the AKA. Furthermore, no SA patient had NCS, while 33% of the non-SA sustained NCS. Conclusions: Successful POI of the AKA may play a key role in prevention of NCS. SA showed the utility of deploying POI, without added morbidity. Furthermore, SA appeared to have a preventive impact on NCS. SA may have a key role on CME which may also be operator dependent.