RESUMO
We report the case of a child suffering from a neonatal cervicomediastinal neuroblastoma encasing the left subclavian artery and the left vertebral artery. There is only a few pediatric tumors extending from the neck to the upper part of the thorax. Because of the complex vascular and neurological anatomy of this area, the surgical excision of these cervicothoracic neuroblastomas is a real challenge. It is why, when we decided to propose a surgical management, we used the Transmanubrial Osteomuscular-Sparing Approach (TOSA), of which technique and benefits will be explained in this article.
Nous rapportons le cas d'un enfant présentant un neuroblastome cervico-médiastinal néonatal engaînant les artères sous-clavière et vertébrale gauches. Les tumeurs s'étendant du cou à la partie supérieure du thorax sont rares en pédiatrie. De plus, l'anatomie vasculo-nerveuse complexe de cette région rend l'exérèse difficile. C'est pourquoi, à l'âge de 20 mois, lorsqu'une prise en charge chirurgicale a été décidée, nous avons utilisé l'approche transmanubriale avec épargne ostéo-musculaire ou TOSA (Transmanubrial Osteomuscular-Sparing Approach) dont nous détaillons la technique et les avantages.
Assuntos
Neuroblastoma , Humanos , Recém-Nascido , Neuroblastoma/cirurgiaRESUMO
OBJECTIVE: Initial enthusiasm for use of cryopreserved arterial allografts was subsequently tempered by suboptimal long-term outcome. Thrombosis, anastomotic pseudo-aneurysm, allograft disruption, aneurysmal degeneration, recurrent intestinal fistulization, and persistent infection are commonly reported in series with long-term follow-up. The authors reviewed their experience over the past 15 years with the use of cryopreserved arterial allografts as a vascular substitute for vascular prosthetic infection or for primary arterial infection, to investigate allograft-related complications. MATERIAL AND METHODS: A retrospective analysis of prospectively collected data was conducted for 103 cryopreserved arterial allografts inserted in 96 patients between July 2000 and July 2015. There were 78 patients with infected vascular prosthesis (IVP), nine patients with an aorto-enteric fistula (AEF), and nine patients with primary arterial infection (PAI). RESULTS: The in-hospital mortality was eight out of 78 (9%) IVP patients, three out of nine AEF patients, and zero out of nine PAI patients. Median follow-up was 49 months. Allograft-related re-interventions were necessary in 29% of the patients with IVP and four of the patients with AEF, but none of the patients with PAI. Five-year survival for the IVP, AEF, and PAI patients was 53%, 44%, and 90%, respectively. CONCLUSION: This series highlights some shortcomings of cryopreserved arterial allografts in the long term, including suboptimal outcome-results and shortage of material. The authors discuss the allograft-related complications and suggest some tricks to minimize their risk.