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McGuire LS, Fuentes A, Charbel FT, Alaraj A, Amin-Hanjani S. Ruptured isolated spinal artery aneurysms: Case series of five patients and a review of the literature on management strategies. Interv Neuroradiol 2023:15910199221149562. [PMID: 36628492 DOI: 10.1177/15910199221149562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Aneurysms of the spinal arteries are rare entities, the majority of which are associated with other vascular lesions, such as spinal vascular malformations. Isolated spinal artery aneurysms (SAAs) are even less frequently encountered, and their incidence is largely unknown, as the literature is limited to case reports and small series. The optimal management strategy for SAAs is not well defined. OBJECTIVE To review the institutional experience of five patients with isolated SAAs. METHODS Five cases of isolated SAAs were identified at our institution, including two cases with multiple simultaneous SAAs. Clinical presentation, imaging, and management strategies for each case were reviewed. A literature review of all SAAs reported between 1950 and 2020 was performed. RESULTS A total of five patients with eight isolated SAAs presented to our institution: one aneurysm was lumbar in location, while the remaining seven were thoracic. Two patients were treated with glue embolization followed by laminectomy for hematoma evacuation; one was treated with only surgery; and the other two, which both had multiple lesions, were managed conservatively with interval complete regression of their aneurysms. All five patients had good neurological outcomes. Literature review found 124 patients with at least 137 isolated SAAs and revealed treatment strategies including conservative management, glue or coil embolization, muslin wrapping, and surgical resection or clipping. CONCLUSION Multiple management strategies exist for SAAs, and clinical consideration of patient presentation and lesion morphology determine appropriate strategy. Our case series demonstrates three of these treatment paradigms.
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Affiliation(s)
- Laura Stone McGuire
- Department of Neurological Surgery, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Angelica Fuentes
- Department of Neurosurgery, 2358University of Virginia, Charlottesville, VA, USA
| | - Fady T Charbel
- Department of Neurological Surgery, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Ali Alaraj
- Department of Neurological Surgery, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Sepideh Amin-Hanjani
- Department of Neurological Surgery, 2546Case Western Reserve University, Cleveland, OH, USA
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Bojanowski MW, Stefanovic K, Bergeron D, Farzin B, Létourneau-Guillon L, Chaalala C. Pregnancy as a Subgroup in the Pathophysiologic Classification of Spinal Aneurysms. World Neurosurg 2021; 157:e264-e270. [PMID: 34637940 DOI: 10.1016/j.wneu.2021.10.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aneurysms of spinal arteries not associated with any known predisposing condition are referred to as isolated spinal aneurysms (SAs). In our series, an SA was found in 2 patients during the postpartum period. The goal of this study is to determine whether an occurrence of an SA may be related to puerperium. METHODS In a retrospective analysis of our consecutive series of 10 cases of SAs from 2008 to 2020, we identified 2 cases of SAs during puerperium. Patients' charts and imaging were reviewed, for potential predisposing factors. RESULTS In both cases, angiography showed fusiform aneurysms of the anterior SA with concomitant bilateral vertebral artery (VA) dissections. Serum vasculitis and inflammatory panel and genetic testing for collagen disorders were negative in both cases. Review of the literature showed that pregnancy is associated with an increased risk of arterial dissections in various locations and supports the hypothesis that hemodynamic and hormonal changes may play a role in the formation of SAs. CONCLUSIONS Pregnancy and peripartum state may be a distinct cause of the formation of SAs, possibly as a result of increased hemodynamic stress and hormonal changes that may alter the arterial wall. It would be appropriate to add pregnancy as a subgroup in the classification of SAs. In our series, both cases were associated with bilateral VA dissections; it is possible that the bilateral VA stenosis may have contributed to the formation of the SAs. It is important to recognize this possibility when considering the occlusion of a dissected VA.
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Affiliation(s)
| | | | - David Bergeron
- Division of Neurosurgery, University of Montreal, Montreal, Canada
| | - Behzad Farzin
- Department of Radiology, University of Montreal, Montreal, Canada
| | | | - Chiraz Chaalala
- Division of Neurosurgery, University of Montreal, Montreal, Canada
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Geraldo AF, Caorsi R, Tortora D, Gandolfo C, Ammendola R, Alessio M, Conti G, Insalaco A, Pastore S, Martino S, Ceccherini I, Signa S, Gattorno M, Rossi A, Severino M. Widening the Neuroimaging Features of Adenosine Deaminase 2 Deficiency. AJNR Am J Neuroradiol 2021; 42:975-979. [PMID: 33632736 DOI: 10.3174/ajnr.a7019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
Adenosine deaminase 2 deficiency (OMIM #615688) is an autosomal recessive disorder characterized by a wide clinical spectrum, including small- and medium-sized vessel vasculopathies, but data focusing on the associated neuroimaging features are still scarce in the literature. Here, we describe the clinical neuroimaging features of 12 patients with genetically proven adenosine deaminase 2 deficiency (6 males; median age at disease onset, 1.3 years; median age at genetic diagnosis, 15.5 years). Our findings expand the neuroimaging phenotype of this condition demonstrating, in addition to multiple, recurrent brain lacunar ischemic and/or hemorrhagic strokes, spinal infarcts, and intracranial aneurysms, also cerebral microbleeds and a peculiar, likely inflammatory, perivascular tissue in the basal and peripontine cisterns. Together with early clinical onset, positive family history, inflammatory flares and systemic abnormalities, these findings should raise the suspicion of adenosine deaminase 2 deficiency, thus prompting genetic evaluation and institution of tumor necrosis factor inhibitors, with a potential great impact on neurologic outcome.
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Affiliation(s)
- A F Geraldo
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Diagnostic Neuroradiology Unit, Imaging Department (A.F.G.), Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Caorsi
- Center for Autoinflammatory Diseases and Immunodeficiencies (R.C., S.S., M.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Tortora
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - C Gandolfo
- Interventional Unit (C.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - R Ammendola
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Alessio
- Department of Translational Medical Sciences (M.A.), Federico II University of Naples, Naples, Italy
| | - G Conti
- Pediatric Nephrology and Rheumatology Unit (G.C.), AOU G Martino, Messina, Italy
| | - A Insalaco
- Division of Rheumatology (A.I.), IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - S Pastore
- Department of Pediatrics (S.P.), Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - S Martino
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics (S.M.), Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - I Ceccherini
- UOSD Genetics and Genomics of Rare Diseases (I.C.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - S Signa
- Center for Autoinflammatory Diseases and Immunodeficiencies (R.C., S.S., M.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiencies (R.C., S.S., M.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences (DISSAL) (A.R.), University of Genoa, Genoa, Italy
| | - M Severino
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Watanabe Y, Takechi A, Kajiwara Y, Miyoshi H. Subarachnoid Hemorrhage Related to a Ruptured Anterior Spinal Artery Aneurysm Associated with Bilateral Vertebral Artery Occlusion. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:107-112. [PMID: 37502805 PMCID: PMC10370808 DOI: 10.5797/jnet.cr.2020-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/06/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a rare case of a ruptured anterior spinal artery (ASA) aneurysm caused by bilateral vertebral artery (VA) occlusion. Case Presentations A 78-year-old man suddenly developed severe headache and slight hemiparesis, and was admitted to our hospital. Computed tomography (CT) revealed subarachnoid hemorrhage, mainly in the posterior fossa. On emergency angiography, the right VA terminated at the origin of the posterior inferior cerebellar artery (PICA), and anastomoses between the PICA and the anterior inferior cerebellar artery (AICA) were observed, in addition to a saccular 3-mm aneurysm with bleb originating from the PICA-AICA anastomosis. Left vertebral arteriography demonstrated that the left VA was occluded segmentally at the V4 level and revealed a tortuous arterial network filling the distal VA. Based on the location of the bleeding, the right VA aneurysm was considered to have ruptured. After balloon test occlusion of the right VA, parent artery occlusion was performed without complications. The patient had no neurological changes immediately after surgery, but several hours later, he stopped breathing. Retrospective analysis revealed an ASA aneurysm, which was determined to be the bleeding source. Although conservative treatment was performed, he died the fourth day after onset without neurological improvement. Conclusion In cases of subarachnoid hemorrhage associated with bilateral VA occlusion, an aneurysm formed by hemodynamic stress may be the source of hemorrhage. It is important to suspect aneurysms in the extracranial collaterals, such as the ASA, and intracranial collaterals such as the PICA-AICA anastomosis.
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Affiliation(s)
- Yosuke Watanabe
- Department of Neurosurgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Akihiko Takechi
- Department of Neurosurgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Yoshinori Kajiwara
- Department of Neurosurgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Hiroyuki Miyoshi
- Department of Neurosurgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
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Ruptured Isolated Aneurysm of a Coronal Branch of the Anterior Spinal Artery: Case Report and Discussion of Treatment Strategies. World Neurosurg 2020; 145:119-126. [PMID: 32949802 DOI: 10.1016/j.wneu.2020.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Isolated spinal artery aneurysms are an extremely rare cause of subarachnoid hemorrhage. A limited number of case reports and case series have been reported in the literature. Treatment options include conservative management, surgical clipping/trapping, and endovascular procedures. Owing to the uncertain natural history of these lesions, there is no consensus about the optimal treatment. CASE DESCRIPTION A 64-year-old man presented with subarachnoid hemorrhage from a ruptured anterior spinal artery aneurysm at the C1 level. Following initial conservative management, surgical treatment was proposed owing to an increase in lesion size at angiographic follow-up. A partially thrombosed aneurysm was found during surgery, suggesting that spontaneous resolution of the aneurysm was occurring. Despite initial worsening of neurological symptoms, the patient gradually recovered after rehabilitation. CONCLUSIONS Treatment decisions for spinal aneurysms should be made on a case-by-case basis, the goal being to offer the patient the best option, while avoiding exposure to unnecessary invasive procedures. As spontaneous resolution of a spinal artery aneurysm is unpredictable, our case highlights the importance of performing a perioperative vascular study if surgery is planned.
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