Strategies of Spinal Tumors Involving the Vertebral Artery : Usefulness of Parent Artery Occlusion before Tumor Resection, and Indication of Balloon Test Occlusion before Parent Artery Occlusion

Abstract

Surgical treatment of tumors at the craniocervical junction or cervical spinal cord that involve the vertebral artery (VA) carries the risk of VA injury, an important consideration given the susceptibility of the vessel to occlusion based on its hemodynamics. Despite this, there is limited literature on the indications and efficacy of balloon test occlusion (BTO) and parent artery occlusion (PAO) for surgical resection of spinal cord tumors. In this study, two out of three patients with tumors at the craniocervical junction or cervical spinal cord involving the VA underwent PAO prior to tumor resection. In one case, BTO preceded PAO to assess ischemic tolerance, particularly due to the anterior spinal artery had branched from the affected side. Following PAO, an asymptomatic stroke occurred with no residual deficits. The decision to forego BTO in the second patient was based on the clear identification of perforating branches of the VA on cerebral angiography. Bleeding during resection was effectively managed, and both cases achieved a stable surgical field. In the third case, BTO was conducted, confirming the feasibility of VA occlusion. However, PAO was declined by the patient. Consequently, during surgery, VA injury necessitated ligation, which was prolonged due to poor visibility, resulting in substantial blood loss (810 ml ) . PAO holds promise in mitigating complications associated with VA injury, facilitating more aggressive tumor resection by promoting devascularization, and ensuring a clearer surgical field.