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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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Chen F, Lu W, Lian B, Kang D, Dai L. Isolated Cervical Ruptured Radiculomedullary Artery Aneurysm Predominantly Presenting as Supratentorial Subarachnoid Hemorrhage: Case Report and Review of the Literature. Brain Sci 2022; 12:brainsci12050519. [PMID: 35624905 PMCID: PMC9138978 DOI: 10.3390/brainsci12050519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/07/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
A spinal artery aneurysm originating from the branch of the extracranial vertebral artery is uncommon. Most of them were finally diagnosed due to the evidence of infratentorial or spinal subarachnoid hemorrhage (SAH). Herein, we report an extremely rare case of a ruptured spinal artery aneurysm which predominantly presented with supratentorial SAH. A 68-year-old woman was initially revealed cranial computed tomographic angiographically negative SAH with a Hunt-Hess grade of 3, while the digital subtraction angiography confirmed an isolated radiculomedullary aneurysm arising from the medial ascending branch of V2 segment at C2 level. The patient underwent surgery in a hybrid operating room. She was originally attempted with coil embolization, but successful clipping of the aneurysm was achieved through unilateral laminectomy at last. Regrettably, the current case suffered a poor clinical outcome due to the complications caused by progressive cerebral vasospasm. In summary, angiogram is of great value for this rare kind of aneurysmal definitive diagnosis. A hybrid operating room may be a feasible choice for the ruptured spinal artery aneurysm.
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Affiliation(s)
- Fuxiang Chen
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; (F.C.); (B.L.); (L.D.)
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350209, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Wen Lu
- Department of Health Management, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China;
| | - Baoqiang Lian
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; (F.C.); (B.L.); (L.D.)
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350209, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Dezhi Kang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; (F.C.); (B.L.); (L.D.)
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350209, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Correspondence:
| | - Linsun Dai
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; (F.C.); (B.L.); (L.D.)
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350209, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
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Malhotra AK, Ku JC, Pereira VM, Radovanovic I. Posterior spinal artery aneurysm as an unlikely culprit for perimesencephalic pattern subarachnoid hemorrhage: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE21103. [PMID: 35855466 PMCID: PMC9245738 DOI: 10.3171/case21103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Angiogram-negative nontraumatic subarachnoid hemorrhage (SAH) can be diagnostically challenging, and a broad differential diagnosis must be considered. Particular attention to initial radiographic hemorrhage distribution is essential to guide adjunctive investigations. Posterior spinal artery aneurysms are rare clinical entities with few reported cases in the literature. An understanding of isolated spinal artery aneurysm natural history, diagnosis, and management is evolving as more cases are identified. OBSERVATIONS Isolated thoracic posterior spinal artery aneurysm can be the culprit lesion in perimesencephalic distribution SAH. Embolization resulted in complete aneurysm occlusion and did not result in periprocedural morbidity. At the 1-year follow-up, the patient was neurologically intact with no recurrence on magnetic resonance angiography. LESSONS This case report highlighted the presentation, diagnostic workup, clinical decision-making, and endovascular intervention for a woman who presented with SAH secondary to posterior spinal artery aneurysm. After initially negative results on vascular imaging, dedicated spinal vascular imaging revealed the location of the aneurysm. Multiple treatment modalities exist for isolated spinal artery aneurysms and must be selected on the basis of patient- and lesion-specific characteristics.
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Affiliation(s)
| | - Jerry C. Ku
- Division of Neurosurgery, Department of Surgery
| | - Vitor M. Pereira
- Division of Interventional Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; and
| | - Ivan Radovanovic
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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Repeated Retching and Vomiting in the Pathophysiology of Isolated Spinal Aneurysms. World Neurosurg 2021; 149:e512-e520. [PMID: 33561554 DOI: 10.1016/j.wneu.2021.01.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rupture of spinal aneurysms is a rare cause of subarachnoid hemorrhage. These aneurysms are often associated with a variety of vascular malformations that increase blood flow in the spinal circulation or with disorders that compromise the vessel wall. However, spinal aneurysms may be isolated, not associated with any known predisposing condition. The objective of this study is to explore the possible mechanisms associated with the formation and rupture of isolated spinal aneurysms (ISAs). METHODS We conducted a retrospective review of a series of consecutive patients admitted for a ruptured ISA. In all cases, spinal angiography confirmed the presence of a spinal aneurysm responsible for the bleeding. Particular attention was paid to medical history and symptoms before bleeding, for potential factors predisposing to their formation and rupture. RESULTS Between 2008 and 2020, ten cases of spinal aneurysms were seen at our institution including 4 cases of ISA. All patients with ISA were female, and in 3 cases the aneurysm involved the territory of the posterior spinal artery. In 3 of these 4 (75%) ISA cases, there was a strikingly similar history of retching and vomiting preceding the thunderclap headache. In 1 patient, the aneurysm was surgically resected; pathologic analysis revealed a fusiform dissecting aneurysm. All 4 patients had a favorable outcome. CONCLUSIONS We suggest that the straining during prolonged retching and vomiting plays a role in the formation and rupture of some ISAs, possibly because of pressure spikes, increased transmural arterial pressure, and increased wall shear stress during straining.
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Crobeddu E, Pilloni G, Zenga F, Cossandi C, Garbossa D, Lanotte M. Dissecting Aneurysm of the L1 Radiculomedullary Artery Associated with Subarachnoid Hemorrhage: A Case Report. J Neurol Surg A Cent Eur Neurosurg 2021; 83:99-103. [PMID: 33540447 DOI: 10.1055/s-0040-1720997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Both spinal artery aneurysm and spinal subarachnoid hemorrhage represent a very rare event. METHODS We report a case of a ruptured dissecting aneurysm of the right L1 radiculomedullary artery associated with subarachnoid hemorrhage and severe motor weakness. RESULTS An urgent decompressive hemilaminectomy was performed due to worsening in motor deficit. A subsequent spinal angiography showed a dissection of radiculomedullary artery of L1 on the right side, treated conservatively. CONCLUSION Nowadays, therapeutic strategies for this aneurysm remain controversial. Conservative strategy can represent a valid alternative.
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Affiliation(s)
- Emanuela Crobeddu
- Department of Neuroscience/Neurosurgery, University of Turin, Novara, Italy
| | - Giulia Pilloni
- Department of Neurosurgery, Hospital Santa Corona Pietra Ligure, Pietra Ligure, Italy
| | - Francesco Zenga
- Department of Neurosurgery, University of Turin, Turin, Italy
| | | | - Diego Garbossa
- Department of Neuroscience/Neurosurgery, University of Turin, Torino, Piemonte, Italy
| | - Michele Lanotte
- Department of Neuroscience/Neurosurgery, University of Turin, Torino, Piemonte, Italy
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Tenorio A, Holmes BB, Abla AA, Amans M, Meisel K. An isolated ruptured spinal aneurysm presents with a thalamic Infarct: case report. BMC Neurol 2021; 21:52. [PMID: 33535981 PMCID: PMC7856767 DOI: 10.1186/s12883-021-02055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Isolated spinal artery aneurysms are extremely rare, and their pathogenesis, clinical presentation, and treatment strategies are poorly established. We report only the second case of a patient with an isolated posterior spinal aneurysm and concurrent left thalamic infarct and review the literature to help clarify treatment strategies of isolated spinal aneurysms. CASE PRESENTATION A 49-year-old patient presented with acute onset walking difficulty followed by diaphoresis, back and abdominal pain, and paraplegia. Imaging was notable for a hemorrhagic spinal lesion with compression at T12 through L4 and an acute left thalamic infarct. Surgical exploration revealed an isolated posterior spinal artery aneurysm. The aneurysm was surgically resected and the patient had partial recovery six months post-operatively. CONCLUSIONS Isolated posterior spinal artery aneurysms of the thoracolumbar region are rare lesions that commonly present with abdominal pain, radiating back pain, and lower extremity weakness. Imaging may not provide a definitive diagnosis. The three primary treatment strategies are conservative management, endovascular treatment, or surgical resection. In patients with symptomatic cord compression, immediate surgical intervention is indicated to preserve neurologic function. In all other cases, the artery size, distal flow, morphology, and location may guide management.
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Affiliation(s)
- Alexander Tenorio
- Department of Neurology, University of California, San Francisco, CA, USA.
| | - Brandon B Holmes
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Adib A Abla
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Matthew Amans
- Department of Neurointerventional Radiology, University of California, San Francisco, CA, USA
| | - Karl Meisel
- Department of Neurology, University of California, San Francisco, CA, USA
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Abdalkader M, Samuelsen BT, Moore JM, Cervantes-Arslanian A, Ong CJ, Setty BN, Mian AZ, Nguyen TN. Ruptured Spinal Aneurysms: Diagnosis and Management Paradigms. World Neurosurg 2020; 146:e368-e377. [PMID: 33223127 DOI: 10.1016/j.wneu.2020.10.098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Spinal aneurysms (SA) are rare neurovascular pathologies with an unclear natural history and management strategy. We review the clinical and radiologic manifestations, management, and outcome of patients who presented with spinal subarachnoid hemorrhage (SAH) secondary to ruptured spinal aneurysms over a 10-year period. We provide a literature review about this condition and its management. METHODS All patients diagnosed with nontraumatic spinal SAH were collected from a single-center prospectively maintained database of patients with SAH between January 2010 and January 2020. Patients diagnosed with spinal aneurysms were reviewed. For each patient, demographic data, clinical presentation, imaging findings, management strategies, and outcomes are reviewed and discussed. RESULTS Between January 2010 and January 2020, ten patients were diagnosed with nontraumatic spinal SAH (3 patients presented with isolated spinal SAH and 7 patients with concomitant spinal and posterior fossa SAH). Among those, 4 patients were found to have a spinal aneurysm as the cause of SAH. The aneurysms were located in the cervical regions in 3 patients (75%) and at the thoracic level in 1 patient. Two aneurysms (50%) involved the anterior spinal artery, and 2 aneurysms (50%) involved a radiculomedullary artery. One aneurysm was a flow-related aneurysm of the anterior spinal artery in the setting of bilateral vertebral artery occlusion and was treated by surgical clipping with good outcome. Three aneurysms were idiopathic pseudoaneurysms with a negative diagnostic evaluation for secondary causes. These pseudoaneurysms were treated conservatively; 2 patients did well and 1 patient passed away from severe intracranial vasospasm. Two aneurysms resolved on diagnostic angiogram, and 1 aneurysm was absent on initial angiogram and appeared on follow-up diagnostic imaging 3 months later. CONCLUSIONS Spinal aneurysms are rare neurovascular pathologies that should be considered in the setting of spinal and/or posterior fossa subarachnoid hemorrhage. Conservative treatment may be a potential safe alternative to interventional treatment. Before the initiation of surgical or endovascular treatment, spinal angiography should be repeated because of the potential for spontaneous resolution.
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Affiliation(s)
- Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA.
| | - Brian T Samuelsen
- School of Medicine, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
| | - Justin M Moore
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Cervantes-Arslanian
- Department of Neurology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA; Department of Neurosurgery, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
| | - Charlene J Ong
- Department of Neurology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA; Department of Neurosurgery, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
| | - Bindu N Setty
- Department of Radiology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
| | - Asim Z Mian
- Department of Radiology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA; Department of Neurology, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA; Department of Neurosurgery, Boston Medical Center, Boston University-School of Medicine, Boston, Massachusetts, USA
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Takebayashi K, Ishikawa T, Murakami M, Funatsu T, Ishikawa T, Taira T, Kawamata T. Isolated Posterior Spinal Artery Aneurysm Presenting with Spontaneous Thrombosis After Subarachnoid Hemorrhage. World Neurosurg 2020; 134:544-547. [DOI: 10.1016/j.wneu.2019.11.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/28/2023]
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Successful Surgical Resection of Spinal Artery Aneurysms: Report of 3 Cases. World Neurosurg 2018; 109:171-178. [DOI: 10.1016/j.wneu.2017.09.174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 12/19/2022]
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Dissecting spinal aneurysms: conservative management as a therapeutic option. J Neurointerv Surg 2017; 10:451-454. [DOI: 10.1136/neurintsurg-2017-013566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 12/12/2022]
Abstract
ObjectiveIsolated dissecting spinal aneurysms are rare lesions that pose a therapeutic challenge. We report our experience in the management of four patients with dissecting spinal aneurysms.MethodsAfter institutional review board approval was obtained, the neurointerventional databases of the two participating institutions were retrospectively reviewed. Aneurysms in the anterior spinal artery, posterior spinal artery, or in a radiculomedullary artery were included in the analysis. Flow-related aneurysms were excluded. Data on clinical presentation, hemorrhage location, aneurysm size, location, angiographic follow-up, re-hemorrhage, and clinical outcome were obtained and analyzed.ResultsFour patients with five spinal dissecting aneurysms met the inclusion criteria. There were two women and the mean age was 63 years (range 36–64). All patients presented with hemorrhage. Three radiculomedullary arteries in two different patients had one lesion each; the other two involved the anterior spinal artery and a posterior spinal artery in different patients. All four patients were managed conservatively. Follow-up angiography (5.5 months) demonstrated occlusion of all five aneurysms. There was no re-hemorrhage and all patients had a good outcome at the last follow-up (modified Rankin Scale score 0–2).ConclusionsConservative management of ruptured spontaneous dissecting spinal aneurysms is a reasonable therapeutic option capable of achieving favorable angiographic and clinical outcomes.
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