Medical Student Duke University Department of Neurosurgery Durham, North Carolina, United States
Introduction: Vascular bypasses are an indispensable tool in the treatment of multiple neurosurgical pathologies. Vascular bypasses are utilized for flow augmentation in conditions such as chronic cerebral ischemia and may also be performed for flow diversion prior to the clipping of a high-risk aneurysm. Bypass may also occur prior to resection of highly vascular tumors, or those encasing critical vascular structures, as is often the case in skull-base meningiomas. To the author’s knowledge, there is no literature describing bypass for the resection of cervical spinal cord tumors . This is despite the important role of vertebral artery (VA) bypass in the treatment of vertebrobasilar insufficiency. We therefore present, to our knowledge, the first use of occipital artery-vertebral artery (OA-VA) bypass in the treatment of a highly vascular, VA-encasing tumor prior to subsequent resection to mitigate subsequent hemorrhage and VA injury.
Methods: The electronic health record was consulted to describe patient demographics and perioperative outcomes as well as to review operative notes, imaging, and further details of the patient’s treatment.
Results: A patient presented with a large, symptomatic cervical spinal cord tumor which, on imaging, encased the left VA. Biopsy revealed a solitary fibrous tumor, a highly vascular lesion. Balloon occlusion testing and embolization were technically impossible due to VA tortuosity. Safe resection required tumor embolization. It was therefore determined that the patient would require VA bypass to replace vertebrobasilar blood flow prior to proximal VA embolization. The patient received OA-VA bypass via the far lateral transcondylar approach, followed by embolization on postoperative day 2, and cervical laminectomy with tumor resection on postoperative day 4. All of the interventions above were without serious complications. The blood loss associated with tumor resection was 700mL. The patient experienced improvement of symptoms with no new neurologic deficits.
Conclusion : In patients with cervical spinal cord tumors that encase or are highly supplied by a dominant or non-redundant VA, VA bypass, followed by embolization allows for safe tumor resection.
