Vertebral Artery Bypass Via Far Lateral Approach for Cervical Spinal Cord Tumor Resection

Background: Arterial bypass can be broadly classified into the categories of flow augmentation or flow replacement/preservation. Flow replacement bypass seeks to preserve blood flow to a territory supplied by a major blood vessel which must ultimately be occluded to facilitate the treatment of an underlying pathology, such as a highly vascular tumor, artery-encasing tumor, or high-risk aneurysm. In this study, the authors describe using a far lateral approach for occipital artery (OA) to vertebral artery (VA) bypass to safely resect a highly vascular cervical spinal tumor.

Methods: The electronic health record was consulted to retrieve information, radiographic and histopathologic images, and operative details surrounding the described patient in order to introduce the concept of VA bypass for tumor resection through an illustrative case.

Results: A patient presented with a highly vascular, VA-supplied, VA-encasing cervical spinal cord tumor (SCT). The patient’s anatomy made safe tumor embolization impossible. It was decided that to reduce the risk of massive tumor hemorrhage, VA injury, or both, that VA bypass should be performed, allowing the external circulation to supply the vertebrobasilar territory. This would allow safe VA embolization, followed by tumor resection. The patient received the aforementioned treatments and benefited from excellent outcomes.

Conclusion: In patients with VA-supplied or VA-encasing lesions, VA bypass followed by tumor embolization can be safely performed prior to tumor resection to reduce the risks of poor outcomes ([Figs 1]–[4]).

Fig. 1 (A) Sagittal and (B) axial T1 MRI with contrast demonstrating large, left-sided, avidly enhancing mass at the level of C1/C2 with extradural and intradural components causing severe cord compression. Cord compression redemonstrated on (C) T2 mid-sagittal MRI.

Fig. 2 Left VA angiography demonstrating proximal tortuosity and tumor blush.

Fig. 3 Left common carotid injection following OA to VA bypass at the level of the neck (left) and head (right) demonstrating patency of the bypass and sufficient filling of the posterior circulation.

Fig. 4 Sagittal (lower) and axial (upper) T2 MRI images of cervical spine preoperatively (left) and postoperatively (right).

Publikationsverlauf

Artikel online veröffentlicht:
05. Februar 2024