University of Rome Tor Vergata, Italy; Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris (APHP), France; Université Paris Saclay, France.
Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris (APHP), France; Université Paris Saclay, France.
J Pediatr Surg. 2024 Dec;59(12):161985. doi: 10.1016/j.jpedsurg.2024.161985. Epub 2024 Oct 3.
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).
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.
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.
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.
我们旨在回顾目前关于在实体性小儿后胸肿瘤（PTT）中预先识别 Adamkiewicz 动脉（AKA）对术前识别（POI）的影响的文献，这些肿瘤包括神经母细胞瘤和神经母细胞瘤在内的神经胚细胞瘤谱，特别关注完全宏观切除（CME）和神经并发症/后遗症（NCS）。
根据 PRISMA 指南进行了系统回顾。该研究包括提供关于在 PTT 中 POI 的 AKA 的可用数据的小儿患者报告。
在筛选出的 838 份记录中，有 33 份全文进行了评估，共有 8 篇论文被纳入。在 49 个肿瘤（N=49 例患者）中，有 30 个是神经外胚层肿瘤。4 项研究对 32 例（65%）患者进行了脊髓血管造影（SA）。未记录到与 SA 相关的发病率。否则，描述了 CT 和/或 MRI 成像的组合。缺乏对 CT/MRI 成像的详细报告，阻碍了对非 SA 成像方式技术的可行详细比较分析。AKA POI 的总体成功率为 65%，SA 为 71%，非 SA 研究为 33%。SA 和非 SA 组的 CME 分别达到 73%和 80%。总体而言，有 5 名儿童出现了 NCS，其中 60%为哑铃型肿瘤。所有的 NCS 均发生在未能成功识别 AKA 的患者中。此外，SA 患者无一例发生 NCS，而非 SA 患者中则有 33%发生了 NCS。
成功的 AKA POI 可能在预防 NCS 中发挥关键作用。SA 显示了部署 POI 的效用，而不会增加发病率。此外，SA 似乎对 NCS 具有预防作用。SA 可能在 CME 中发挥关键作用，这也可能依赖于操作者。
