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

Not yet recruiting

• Conditions: Tumor, Solid; Neuroblastic Tumors; Neuroblastoma

• Registration Number: NCT06798532
• Lead Sponsor: Assistance Publique - Hôpitaux de Paris

Brief Summary

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.

Detailed Description

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.

It seems that in France, unlike other European sites, there is no systematic search for the artery of Adamkiewicz before surgery for neuroblastic tumors in most pediatric surgery departments. It does not seem that this is responsible for postoperative neurological complications but this assessment has never been performed.

The hypothesis of the study is that the neurological complications observed postoperatively are due to nerve root surgery or to spinal cord injury by direct trauma through the foramens, but not to spinal cord ischemia.

Study Timeline

• Status Verified: 2025-01
• Study First Submitted: 2025-01-17
• Study First Submitted QC: 2025-01-27
• Last Update Submitted: 2025-01-27
• Study First Posted: 2025-01-29
• Last Update Posted: 2025-01-29
• Study Start: 2025-03
• Primary Completion: 2025-09
• Study Completion: 2025-09

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 150

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

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Occurrence of neurological complications secondary to spinal cord ischemia	2005 to 2024	Assessment of postoperative neurological complications in patients undergoing surgery for basi-thoracic NBT, with or without preoperative spinal cord arteriography.

Secondary Outcome Measures

Name	Time	Method
Demographic characteristics of patients undergoing surgery for basithoracic neuroblastic tumor	2005 to 2024	Describe the demographic characteristics of patients undergoing surgery for basithoracic neuroblastic tumor.
Outcome of patients undergoing surgery for basithoracic neuroblastic tumor	2005 to 2024	Describe the overall survival and recurrence-free survival.

Trial Locations

Locations (27)

Hôpital Robert Debré; 🇫🇷 Paris, France

CHU de Rouen; 🇫🇷 Rouen, France

CHU de La Réunion; 🇫🇷 Saint-denis, France

CHU de Strasbourg; 🇫🇷 Strasbourg, France

CHU de Toulouse; 🇫🇷 Toulouse, France

CHU de Tours; 🇫🇷 Tours, France

CHU d'Amiens; 🇫🇷 Amiens, France

CHU de Besançon; 🇫🇷 Besançon, France

CHU de Bordeaux; 🇫🇷 Bordeaux, France

CHU de Brest; 🇫🇷 Brest, France

CHU de Lyon; 🇫🇷 Bron, France

CHU de Caen; 🇫🇷 Caen, France

CHU de Dijon; 🇫🇷 Dijon, France

CHU de Grenoble; 🇫🇷 Grenoble, France

Hôpital Bicêtre; 🇫🇷 Le Kremlin-Bicêtre, France

CHU de Lille; 🇫🇷 Lille, France

CHU de Limoges; 🇫🇷 Limoges, France

CHU de Marseille; 🇫🇷 Marseille, France

CHU de Montpellier; 🇫🇷 Montpellier, France

CHU de Nancy; 🇫🇷 Nancy, France

CHU Nantes; 🇫🇷 Nantes, France

CHU Nice; 🇫🇷 Nice, France

Hôpital Trousseau; 🇫🇷 Paris, France

Hôpital Necker enfants malades; 🇫🇷 Paris, France

CHU de Poitiers; 🇫🇷 Poitiers, France

CHU de Reims; 🇫🇷 Reims, France

CHU de Rennes; 🇫🇷 Rennes, France