Spinal cord ischaemia after radical pleurectomy/decortication operation for mesothelioma

Our plain-English summary of Spinal cord ischaemia after radical pleurectomy/decortication operation for mesothelioma, by E. Kaba, M.O. Özyurtkan, L. Onat, et al (European Journal of Cardio-thoracic Surgery, 2016).

The study

• Authors: E. Kaba, M.O. Özyurtkan, L. Onat, K. Ayalp
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2016;50(6):1212-1214
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Radical pleurectomy/decortication was performed in a patient with malignant pleural mesothelioma. During the surgery, the left subclavian artery was injured, and repaired via resection and anastomosis. However, the patient was diagnosed with paraplegia following extubation. After deliberate investigations, the mechanism of injury to the critical vascular zone of the spinal cord was determined. Here, we aim to draw attention to possible similar injuries.

© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

In plain English

This was a case report from a hospital in Istanbul, Turkey, about one 62-year-old man with malignant pleural mesothelioma. He had a radical pleurectomy/decortication, an operation to remove the lining around the lung, through the left side of the chest. The article does not discuss asbestos exposure. During surgery the left subclavian artery was injured and repaired. When the breathing tube was removed, he could not move both legs and the left arm. MRI showed an infarction (tissue damage from lost blood supply) in the front of the spinal cord at the T4 to T6 levels. Some paralysis cleared the next day, but the left leg stayed paralysed, with slight improvement after 6 weeks of physiotherapy. Angiography showed the repair was intact, but the artery's branches, including the left vertebral artery, were not visible. Earlier CT scans suggested the left vertebral artery was possibly the dominant one. After readmission for severe pneumonia, he died despite treatment in the fourth postoperative month. The authors concluded that this damage might have impaired spinal cord blood flow and caused the paralysis. They recommended checking for a dominant vertebral artery before surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 62-year-old man with malignant pleural mesothelioma, treated at Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey. The date of treatment is not given.
• Exposure: No asbestos exposure is described. The event studied is the surgery: radical pleurectomy/decortication with diaphragmatic and pericardial resection via left thoracotomy, during which the left subclavian artery was injured and repaired by end-to-end anastomosis.
• Main results:
  • After extubation in intensive care, the patient could not move both legs or the left arm.
  • MRI showed hyper-acute infarction in the anterior spinal cord at the T4 to T6 levels.
  • After treatment to support spinal cord blood flow (mean arterial pressure kept above 80 mmHg; intravenous bolus of low-molecular-weight heparin, 15000 IU), the paralysis regressed the next day except in the left leg, which remained paralysed.
  • Angiography showed a preserved Adamkiewicz artery.
  • The subclavian artery repair was intact, but its branches (left vertebral, thyrocervical truncus and costocervical truncus arteries) were not visible.
  • Re-examined preoperative CT images suggested the left vertebral artery was possibly dominant, being larger than the right.
  • After 6 weeks of physiotherapy, there was slight improvement in left leg motor function.
  • After discharge the patient was readmitted with severe bilateral pneumonia and died despite treatment in the fourth postoperative month. The article does not state the cause of death.
• The authors' conclusion: The authors concluded that damage to the left subclavian and vertebral arteries, of which only the subclavian was reconstructed, and to the thyrocervical and costocervical truncus arteries might have impaired spinal cord blood flow at T4 to T6 and provoked paraplegia. They recommended determining before surgery whether a dominant vertebral artery is present.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Mesothelioma, Pleural Mesothelioma.

Related studies

• Spinal cord ischemia resulting in paraplegia following extrapleural pneumonectomy — K. Ural, K. Jakob, et al. (2014)
• Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma — N.M. Mollberg, Y. Vigneswaran, et al. (2012)
• Intradural intramedullary spinal cord metastasis due to mesothelioma — M.C. Chamberlain, K.D. Eaton, et al. (2010)
• Extensive epidural cufflike growth of malignant pleural mesothelioma causing spinal cord compression — J.M. Gijtenbeek, H.I. Brouwer, et al. (2002)
• Cyberknife radiosurgery for focal paravertebral recurrence after radical pleurectomy/decortication in malignant pleural mesothelioma — L. Lang-Lazdunski, S. Barrington, et al. (2012)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)

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