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

NCT ID: NCT06798532

Last Updated: 2025-09-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Total Enrollment

150 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-10-31

Study Completion Date

2026-04-30

Brief Summary

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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

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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.

Conditions

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Tumor, Solid Neuroblastic Tumors Neuroblastoma

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

RETROSPECTIVE

Study Groups

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Pediatric patients

Patients undergoing surgery for a neuroblastic tumor (neuroblastoma, ganglioneuroblastoma) with basi-thoracic location between T8 and L1, with or without intraspinal component and treated in a pediatric surgery department in France between 2005 and 2024.

Collection of data from the patient's medical file.

Intervention Type OTHER

Collection of data from the patient's medical file.

Interventions

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Collection of data from the patient's medical file.

Collection of data from the patient's medical file.

Intervention Type OTHER

Eligibility Criteria

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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
Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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URC-CIC Paris Descartes Necker Cochin

OTHER

Sponsor Role collaborator

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marianna MD Cornet

Role: PRINCIPAL_INVESTIGATOR

Assistance Publique - Hôpitaux de Paris

Sabine MD, PhD Sarnacki

Role: PRINCIPAL_INVESTIGATOR

Assistance Publique - Hôpitaux de Paris

Locations

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CHU d'Amiens

Amiens, , France

Site Status

CHU de Besançon

Besançon, , France

Site Status

CHU de Bordeaux

Bordeaux, , France

Site Status

CHU de Brest

Brest, , France

Site Status

CHU de Lyon

Bron, , France

Site Status

CHU de Caen

Caen, , France

Site Status

CHU de Dijon

Dijon, , France

Site Status

CHU de Grenoble

Grenoble, , France

Site Status

Hôpital Bicêtre

Le Kremlin-Bicêtre, , France

Site Status

CHU de Lille

Lille, , France

Site Status

CHU de Limoges

Limoges, , France

Site Status

CHU de Marseille

Marseille, , France

Site Status

CHU de Montpellier

Montpellier, , France

Site Status

CHU de Nancy

Nancy, , France

Site Status

CHU Nantes

Nantes, , France

Site Status

CHU Nice

Nice, , France

Site Status

Hôpital Trousseau

Paris, , France

Site Status

Hôpital Necker enfants malades

Paris, , France

Site Status

Hôpital Robert Debré

Paris, , France

Site Status

CHU de Poitiers

Poitiers, , France

Site Status

CHU de Reims

Reims, , France

Site Status

CHU de Rennes

Rennes, , France

Site Status

CHU de Rouen

Rouen, , France

Site Status

CHU de La Réunion

Saint-Denis, , France

Site Status

CHU de Strasbourg

Strasbourg, , France

Site Status

CHU de Toulouse

Toulouse, , France

Site Status

CHU de Tours

Tours, , France

Site Status

Countries

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France

Central Contacts

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Sabine MD, PhD Sarnacki

Role: CONTACT

0033144494194

Hélène Morel

Role: CONTACT

0033171196346

Facility Contacts

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Xavier MD Delforge

Role: primary

0033322087560

Yann MD Chaussy

Role: primary

0033381219403

Frederic MD Lavrand

Role: primary

0033557821948

Philine MD, PhD de Vries

Role: primary

0033298223926

Frédéric MD Hameury

Role: primary

0033427869217

Jean-Baptiste MD Marret

Role: primary

0033231064489

Emmanuel MD, PhD Sapin

Role: primary

0033380293415

Christian MD, PhD Piolat

Role: primary

0033476765900

Florent MD, PhD Guérin

Role: primary

0033145213191

Dyuti MD Sharma

Role: primary

0033320444343

Quentin MD Ballouhey

Role: primary

0033555058684

Anne MD Dariel

Role: primary

0033491386682

Nicolas MD, PhD Kalfa

Role: primary

0033467338784

Ludovic MD Mansuy

Role: primary

0033383598542

Marc-David MD, PhD Leclair

Role: primary

0033240083585

Jean-François MD Lecompte

Role: primary

0033492030316

Sabine MD, PhD Irtan

Role: primary

0033144736302

Marianna MD Cornet

Role: primary

0033679699489

Pascale MD Chomette

Role: primary

0033186468216

Aurelien MD, PhD Binet

Role: primary

0033549444444

Antoine MD Liné

Role: primary

0033326787578

Alexis MD, PhD Arnaud

Role: primary

0033299265930

Agnès MD, PhD Liard-Zmuda

Role: primary

0033232888990

Jean-Luc MD Michel

Role: primary

00262262905490

Sarah MD Jannier

Role: primary

0033388128097

Olivier MD, PhD Abbo

Role: primary

0033534558516

Hubert MD, PhD Lardy

Role: primary

0033247473820

References

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Lindeire S, Hauser JM. Anatomy, Back, Artery of Adamkiewicz. 2025 Mar 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK532971/

Reference Type BACKGROUND
PMID: 30422566 (View on PubMed)

Nordin AB, Fallon SC, Jea A, Kim ES. The use of spinal angiography in the management of posterior mediastinal tumors: case series and review of the literature. J Pediatr Surg. 2013 Sep;48(9):1871-7. doi: 10.1016/j.jpedsurg.2013.04.029.

Reference Type BACKGROUND
PMID: 24074660 (View on PubMed)

Schmidt A, Hempel JM, Ellerkamp V, Warmann SW, Ernemann U, Fuchs J. The Relevance of Preoperative Identification of the Adamkiewicz Artery in Posterior Mediastinal Pediatric Tumors. Ann Surg Oncol. 2022 Jan;29(1):493-499. doi: 10.1245/s10434-021-10381-8. Epub 2021 Jul 31.

Reference Type BACKGROUND
PMID: 34331163 (View on PubMed)

Bosmia AN, Hogan E, Loukas M, Tubbs RS, Cohen-Gadol AA. Blood supply to the human spinal cord: part I. Anatomy and hemodynamics. Clin Anat. 2015 Jan;28(1):52-64. doi: 10.1002/ca.22281. Epub 2013 Jun 27.

Reference Type BACKGROUND
PMID: 23813725 (View on PubMed)

De Bernardi B, Gambini C, Haupt R, Granata C, Rizzo A, Conte M, Tonini GP, Bianchi M, Giuliano M, Luksch R, Prete A, Viscardi E, Garaventa A, Sementa AR, Bruzzi P, Angelini P. Retrospective study of childhood ganglioneuroma. J Clin Oncol. 2008 Apr 1;26(10):1710-6. doi: 10.1200/JCO.2006.08.8799.

Reference Type BACKGROUND
PMID: 18375900 (View on PubMed)

Furak J, Geczi T, Tiszlavicz L, Lazar G. Postoperative paraplegia after resection of a giant posterior mediastinal tumour. Importance of the blood supply in the upper spinal cord. Interact Cardiovasc Thorac Surg. 2011 May;12(5):855-6. doi: 10.1510/icvts.2010.257105. Epub 2011 Feb 8.

Reference Type BACKGROUND
PMID: 21303870 (View on PubMed)

Boglino C, Martins AG, Ciprandi G, Sousinha M, Inserra A. Spinal cord vascular injuries following surgery of advanced thoracic neuroblastoma: an unusual catastrophic complication. Med Pediatr Oncol. 1999 May;32(5):349-52. doi: 10.1002/(sici)1096-911x(199905)32:53.0.co;2-p.

Reference Type BACKGROUND
PMID: 10219336 (View on PubMed)

Other Identifiers

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APHP241337

Identifier Type: -

Identifier Source: org_study_id

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