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Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
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Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
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2
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Sokol Z, Oselkin M. Spinal subarachnoid hemorrhage as a consequence of dissection with pseudoaneurysm in a cervical radiculomedullary branch of the anterior spinal artery. Radiol Case Rep 2024; 19:403-407. [PMID: 38033669 PMCID: PMC10681874 DOI: 10.1016/j.radcr.2023.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Spinal subarachnoid hemorrhage is a rare condition, and it generally arises as a consequence of arteriovenous malformation, although more rarely can be caused by aneurysm, dissection, or pseudoaneurysm. In the following, we present a case of a 58-year-old male who while undergoing treatment for nephrolithiasis, developed persistent hypertension, refractory to his home medications, along with headache, neck pain, and unilateral ptosis and upper extremity ataxia. Initial CT scan demonstrated acute subarachnoid hemorrhage in the posterior fossa extending to the C7 level, Angiography ultimately revealed a focal irregularity compatible with dissection and 1mm pseudoaneurysm within the left anterior spinal artery radiculomedullary feeder at the C5-6 level. The patient was managed conservatively with 81mg ASA and repeat angiography revealed resolution of the lesion, in concordance with management of dissection and pseudoaneurysm of the carotid and vertebral arteries. Subarachnoid hemorrhage as a consequence of dissection and pseudoaneurysm of a cervical radiculomedullary feeder has been previously unreported in the literature.
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Affiliation(s)
- Zachary Sokol
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St. Bethlehem, PA 18015 USA
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad St, Philadelphia, PA 19140 USA
| | - Martin Oselkin
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St. Bethlehem, PA 18015 USA
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3
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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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4
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Hiett A, Gaughan Z, Polston K, Clark M. Ruptured aneurysm of the artery of Adamkiewicz as a rare cause of spinal cord injury. BMJ Case Rep 2022; 15:e250840. [PMID: 36007976 PMCID: PMC9422830 DOI: 10.1136/bcr-2022-250840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case report describes a patient who presented with low back pain, headache and urinary retention. He developed altered mental status with right lower extremity hemiparesis. He was subsequently found to have subarachnoid haemorrhage and was ultimately diagnosed with a ruptured aneurysm of the artery of Adamkiewicz. At 11-week follow-up, he had made a significant recovery and was functioning at a modified independent level. This case report explores previous cases of ruptured artery of Adamkiewicz aneurysms as a rare cause of spinal cord injury, and discusses management and recovery for these injuries.
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Affiliation(s)
- Andrew Hiett
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Zachary Gaughan
- Department of Radiology, University of Missouri, Kansas City, Missouri, USA
| | - Keith Polston
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Megan Clark
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
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5
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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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6
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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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7
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Nakamura T, Ueno T, Arai A, Iwamura M, Midorikawa H, Murakami K, Tomiyama M. Subarachnoid Hemorrhage Caused by Ruptured Aneurysm of the Artery of Adamkiewicz: a Case Report. J Stroke Cerebrovasc Dis 2020; 29:105224. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
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8
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Cobb M, Griffin A, Karikari I, Gonzalez LF. Endovascular Treatment of Ruptured Enlarging Dissecting Anterior Spinal Artery Aneurysm. World Neurosurg 2020; 139:e658-e662. [DOI: 10.1016/j.wneu.2020.04.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 12/20/2022]
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9
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Yokosuka J, Fukaya S, Yamomoto S, Ueki K, Kim P. Intracranial subarachnoid hemorrhage caused by an aneurysm at the thoracic spinal region: case report and literature review. Br J Neurosurg 2019; 34:672-676. [PMID: 31747814 DOI: 10.1080/02688697.2019.1690130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The most common cause of intracranial subarachnoid hemorrhage (SAH) is an intracranial aneurysm or other vascular lesion; however, spinal lesions have also been implicated. Furthermore, vascular lesions rarely occur in the thoracolumbar region. We herein presented a case of intracranial SAH caused by an isolated aneurysm in the thoracic spinal artery.Case presentation: A 79-year-old woman developed the sudden onset of headaches in the parietal and occipital regions followed by vomiting. Head computed tomography (CT) scans showed SAH in the basal cistern and around the parietal lobe cortex. Cerebral angiography detected no aneurysm or vascular malformation. Spinal CT on day 1 showed extensive SAH at the posterior surface of the spinal cord, which was the most prominent at the level of T9/10, and spinal angiography subsequently revealed an aneurysm fed by the T10 radicular artery. The aneurysm was resected by T8-10 laminectomy, and the patient recovered with no long-term neurological deficit.Conclusions: A literature review revealed 17 cases of intracranial SAH from thoracolumbar vascular lesions. Most cases resulted in poor functional outcomes, which occurred in the later phase of the disease and may have been avoided with earlier diagnoses and interventions. We suggest whole spine CT as a useful tool for rapid screening of this rare lesion, and is recommended when an initial survey for intracranial lesions does not detect any likely lesions. Furthermore, ventricular reflux on head CT may lead to an accurate diagnosis in the absence of spinal symptoms.
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Affiliation(s)
- Junichi Yokosuka
- Department of Neurosurgery, Dokkyo Medical University, Mibu, Japan
| | - Shunsuke Fukaya
- Department of Neurosurgery, Dokkyo Medical University, Mibu, Japan
| | - Shinji Yamomoto
- Department of Neurosurgery, Dokkyo Medical University, Mibu, Japan
| | - Keisuke Ueki
- Department of Neurosurgery, Dokkyo Medical University, Mibu, Japan
| | - Phyo Kim
- Department of Neurosurgery, Dokkyo Medical University, Mibu, Japan
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10
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Priola SM, Heyn C, da Costa L. Minimally Invasive Approach for the Removal of a Ruptured Radiculomedullary Artery Aneurysm: Case Report and Literature Review. World Neurosurg 2019; 126:605-610. [DOI: 10.1016/j.wneu.2019.03.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/21/2019] [Indexed: 01/05/2023]
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11
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Emergency Embolization of Artery of Adamkiewicz Pseudoaneurysm Following Methylenedioxymethamphetamine Abuse. Can J Neurol Sci 2019; 46:140-144. [PMID: 30688204 DOI: 10.1017/cjn.2018.372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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12
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Spinal adhesive arachnoiditis following the rupture of an Adamkiewicz aneurysm: Literature review and a case illustration. Neurochirurgie 2018; 64:177-182. [DOI: 10.1016/j.neuchi.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/06/2017] [Accepted: 11/27/2017] [Indexed: 02/04/2023]
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13
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Aguilar-Salinas P, Lima J, Brasiliense LBC, Hanel RA, Sauvageau E. Republished: Ruptured aneurysm of the artery of Adamkiewicz: is conservative management the standard of treatment in the current era? J Neurointerv Surg 2018; 10:e22. [DOI: 10.1136/neurintsurg-2017-013194.rep] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 11/04/2022]
Abstract
Spinal aneurysms are rare lesions, and their natural history is not well known. In particular, aneurysms arising from the artery of Adamkiewicz (AA) are an extremely rare phenomenon, and given the lack of solid evidence its management remains unclear. We present the case of a 54-year-old woman with spinal subarachnoid hemorrhage. A spinal angiogram demonstrated a fusiform aneurysm arising from the AA. Based on the location, the absence of evident collateral circulation to the anterior spinal artery, and the available literature supporting spontaneous thrombosis, we opted for conservative management. Fifteen days after the diagnosis, a spinal angiogram demonstrated complete occlusion of the aneurysm with no visualization of the AA. At 10-month follow-up, the patient was able to walk without assistance. Management should be done on a case-by-case basis with the goal of preserving spinal cord perfusion. Similar to previous articles, our report reinforces conservative management as a valid strategy.
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14
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Surgical Management of Ruptured Isolated Aneurysm of Artery of Adamkiewicz: Interesting Report and Overview of Literature. World Neurosurg 2018; 111:36-40. [DOI: 10.1016/j.wneu.2017.11.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 12/28/2022]
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15
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Aguilar-Salinas P, Lima J, Brasiliense LBC, Hanel RA, Sauvageau E. Ruptured aneurysm of the artery of Adamkiewicz: is conservative management the standard of treatment in the current era? BMJ Case Rep 2017; 2017:bcr-2017-013194. [PMID: 29030496 DOI: 10.1136/bcr-2017-013194] [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: 11/04/2022] Open
Abstract
Spinal aneurysms are rare lesions, and their natural history is not well known. In particular, aneurysms arising from the artery of Adamkiewicz (AA) are an extremely rare phenomenon, and given the lack of solid evidence its management remains unclear. We present the case of a 54-year-old woman with spinal subarachnoid hemorrhage. A spinal angiogram demonstrated a fusiform aneurysm arising from the AA. Based on the location, the absence of evident collateral circulation to the anterior spinal artery, and the available literature supporting spontaneous thrombosis, we opted for conservative management. Fifteen days after the diagnosis, a spinal angiogram demonstrated complete occlusion of the aneurysm with no visualization of the AA. At 10-month follow-up, the patient was able to walk without assistance. Management should be done on a case-by-case basis with the goal of preserving spinal cord perfusion. Similar to previous articles, our report reinforces conservative management as a valid strategy.
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Affiliation(s)
- Pedro Aguilar-Salinas
- Department of Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Jussie Lima
- Department of Neurology, University of Connecticut, Farmington, Connecticut, USA
| | | | - Ricardo A Hanel
- Department of Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Department of Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
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16
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Kim SB, Ban SP, Kim HJ, Kwon OK. Surgical Removal of a Ruptured Radiculomedullary Artery Aneurysm: A Case Report. J Cerebrovasc Endovasc Neurosurg 2017; 19:217-222. [PMID: 29159157 PMCID: PMC5680087 DOI: 10.7461/jcen.2017.19.3.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/14/2017] [Accepted: 09/25/2017] [Indexed: 11/23/2022] Open
Abstract
Subarachnoid hemorrhage due to a solitary spinal aneurysm is extremely rare, and diagnosis and treatment are challenging. We report a rare case of a ruptured radiculomedullary artery aneurysm in a patient with Behçet disease. A 49-year-old man presented with severe lower abdominal and leg pain. Magnetic resonance imaging was performed and an enhanced intradural-extramedullary lesion at the T12 spinal level with subarachnoid hemorrhage was identified. Diagnostic spinal angiography was performed to evaluate the vascular lesion, and a radiculomedullary artery aneurysm at the T12 level was identified. We performed surgical resection of the aneurysm and a good neurological outcome was obtained.
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Affiliation(s)
- Seung Bin Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Pil Ban
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
Spinal subarachnoid hemorrhage (SAH) is a rare disease. Spinal aneurysms are even rarer and mostly undetected unless they rupture and become symptomatic. In this chapter we aim to review the available literature about spinal subarachnoid hematoma with special emphasis on spinal aneurysms. As most reports of spinal aneurysms describe a single case or a small case series, the diagnostic algorithm is often lacking. The outcome is also different based on the etiologies; therefore management strategy must be individualized. We addressed these issues in this chapter. The reported incidence of spinal SAH is less than epidural hematoma and more than subdural hematoma. Spinal aneurysms can present as isolated entity or can be associated with other vascular anomalies. Microsurgical clipping and/or resection is possible, especially when they are located dorsally or dorsolaterally. Endovascular approach is also a feasible option unless negotiation of microcatheter becomes difficult in tortuous small-caliber arteries. Successful obliteration leads to good outcome, especially when present in posterior spinal artery. A detailed knowledge of spinal SAH and spinal aneurysms is important to detect them in time. Clinicians must consider several factors to choose an appropriate treatment strategy to ensure the safety of their patients.
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Affiliation(s)
- Tanmoy K Maiti
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Shyamal C Bir
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
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18
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Doberstein CA, Bouley A, Silver B, Morrison JF, Jayaraman MV. Ruptured aneurysms of the intradural artery of adamkiewicz: Angiographic features and treatment options. Clin Neurol Neurosurg 2016; 146:152-5. [DOI: 10.1016/j.clineuro.2016.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/03/2016] [Accepted: 05/12/2016] [Indexed: 12/28/2022]
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19
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Rupture of the retrocorporeal artery: a rare cause of spontaneous spinal epidural haematoma. Acta Neurochir (Wien) 2016; 158:1121-4. [PMID: 27106842 DOI: 10.1007/s00701-016-2806-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
A 22-year-old man presented with a sudden backache and paraplegia (ASIA = B). Magnetic resonance imaging showed an anterior pan-spinal epidural haematoma. Digital subtraction angiography was performed and ruled out an underlying vascular malformation but showed an active contrast media leakage into the T-4 ventral epidural space with a pattern of pseudo-aneurysm. A rupture of a T-4 retrocorporeal artery was considered as the aetiology, possibly caused by a haemorrhagic sub-adventitial dissection. Treatment consisted in the embolisation of both the pseudo-aneurysm and the parent artery with liquid acrylic glue, followed by neurosurgical decompression in emergency. The patient had totally recovered (ASIA = E) by the 10-month clinical follow-up.
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20
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N'da HA, Chenin L, Capel C, Havet E, Le Gars D, Peltier J. Microsurgical anatomy of the Adamkiewicz artery-anterior spinal artery junction. Surg Radiol Anat 2015; 38:563-7. [PMID: 26627692 DOI: 10.1007/s00276-015-1596-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study is to describe the anterior spinal artery-Adamkiewicz artery (ASA-AKA) junction and establish a classification allowing defining the neurological risk in either thoracoabdominal aorta aneurysm treatment and in anterior or transforaminal thoracolumbar spine surgery. METHODS Fifteen spinal cords of fresh cadavers were dissected. Both lumbar arteries and ASA were injected with strongly diluted red-colored silicon. RESULTS The dural crossing of AKA was located on the left side in 86 % of cases, between T8 and T10 in 73.33 % of cases and L1-L2 in 26.67 % of cases. The average diameter of the ascending branch of AKA was 1.10 mm (range 0.8-1.9 mm), and its average length was 30.27 mm (range 12.3-60 mm). The AKA's arch average diameter was 11.3 mm (range 9-20 mm) with an open downward angle average of 20.1° (range 11°-30°). The descending branch of AKA which was a continuation of ASA had an average diameter of 1.33 mm (range 0.8-1.86 mm). The ASA at the top of the arch had an average diameter of 0.74 mm (range 0.2-1.77 mm). According to these findings, we have proposed a new classification with two types of junctions. The type I and its variant correlated to high neurological risk were present in 93.33 % of cases. The type II, correlated to medium or low neurological risk, was present in 6.67 % of cases. CONCLUSION These anatomical findings allow a planning of the neurological risk before thoracoabdominal aorta aneurysm or thoracolumbar anterior or transforaminal spine surgery.
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Affiliation(s)
- Hermann Adonis N'da
- Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France.
| | - Louis Chenin
- Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France
| | - Cyril Capel
- Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France
| | - Eric Havet
- Laboratoire d'Anatomie et d'Organogénèse, Université de Picardie Jules Verne, 80036, Amiens Cedex 1, France
| | - Daniel Le Gars
- Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France.,Laboratoire d'Anatomie et d'Organogénèse, Université de Picardie Jules Verne, 80036, Amiens Cedex 1, France
| | - Johann Peltier
- Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France.,Laboratoire d'Anatomie et d'Organogénèse, Université de Picardie Jules Verne, 80036, Amiens Cedex 1, France
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21
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Boeris D, Mortimer A, Sakthithasan M, Evins AI, Sandeman D, Renowden S. Republished: Conservative management of a post-traumatic pseudoaneurysm of the artery of cervical enlargement–anterior spinal artery junction. J Neurointerv Surg 2015; 8:e14. [DOI: 10.1136/neurintsurg-2015-011662.rep] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/05/2015] [Indexed: 11/04/2022]
Abstract
A 22-year-old man suffered severe sudden onset head and neck pain after being pushed from behind during an assault. Physical examination was normal. Cervical MRI demonstrated an intradural hematoma, anterior to the cord, between C2–4. Subsequent contrast enhanced MR angiography and digital subtraction vertebral angiography confirmed that the cause of the hemorrhage was a fusiform (presumed dissecting) pseudoaneurysm of the artery of the cervical enlargement at its junction with the anterior spinal artery. The aneurysm was managed conservatively. Follow-up angiography demonstrated that the aneurysm had spontaneously thrombosed within 10 days and remained occluded at 2 months. The patient remained occluded at 6 months following the initial injury. Anterior spinal aneurysms represent a management dilemma and options are discussed.
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22
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Boeris D, Mortimer A, Sakthithasan M, Evins AI, Sandeman D, Renowden S. Conservative management of a post-traumatic pseudoaneurysm of the artery of cervical enlargement-anterior spinal artery junction. BMJ Case Rep 2015; 2015:bcr-2015-011662. [PMID: 25809436 DOI: 10.1136/bcr-2015-011662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 22-year-old man suffered severe sudden onset head and neck pain after being pushed from behind during an assault. Physical examination was normal. Cervical MRI demonstrated an intradural hematoma, anterior to the cord, between C2-4. Subsequent contrast enhanced MR angiography and digital subtraction vertebral angiography confirmed that the cause of the hemorrhage was a fusiform (presumed dissecting) pseudoaneurysm of the artery of the cervical enlargement at its junction with the anterior spinal artery. The aneurysm was managed conservatively. Follow-up angiography demonstrated that the aneurysm had spontaneously thrombosed within 10 days and remained occluded at 2 months. The patient remained occluded at 6 months following the initial injury. Anterior spinal aneurysms represent a management dilemma and options are discussed.
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Affiliation(s)
- Davide Boeris
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alex Mortimer
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Mathuri Sakthithasan
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alexander Ian Evins
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - David Sandeman
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Shelly Renowden
- Department of Neuroradiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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23
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Ronchetti G, Morales-Valero SF, Lanzino G, Wald JT. A Cause of Atypical Intracranial Subarachnoid Hemorrhage: Posterior Spinal Artery Aneurysms. Neurocrit Care 2014; 22:299-305. [DOI: 10.1007/s12028-014-0009-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Surgical management of cervical radiculomedullary arterial aneurysm with subarachnoid haemorrhage: a case report. Neurochirurgie 2014; 60:265-8. [PMID: 24951379 DOI: 10.1016/j.neuchi.2014.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 02/16/2014] [Accepted: 03/29/2014] [Indexed: 12/26/2022]
Abstract
The aim of this paper was to report an unusual case of a 30-year-old woman admitted to the emergency department for a subarachnoid spinal haemorrhage. Clinical presentation was typical and the initial CT-scan did not show any intracranial lesions. Diagnosis was then confirmed by a full-spinal MRI that revealed a cervical radiculomedullary artery aneurysm. The diagnosis was also confirmed by an arteriography that showed a left C6 radiculomedullary artery aneurysm. Surgical management was performed and included a direct approach of the vascular lesion using an anterolateral cervicotomy and occlusion of the parent vessel. Histological examination confirmed the typical aspect of the aneurysm. The postoperative course was uneventful and the patient was discharged from hospital at day 15. This type of vascular lesion is very uncommon and requires a prompt diagnosis. Initial MRI can confirm the presence of a subarachnoid haemorrhage related to the aneurysm, which can be also visualized by an arteriography. Management of these vascular disorders requires a multidisciplinary specialized spine-team and is commonly performed using a direct surgical approach.
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25
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Son S, Lee SG, Park CW. Solitary ruptured aneurysm of the spinal artery of adamkiewicz with subarachnoid hemorrhage. J Korean Neurosurg Soc 2013; 54:50-3. [PMID: 24044082 PMCID: PMC3772288 DOI: 10.3340/jkns.2013.54.1.50] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 04/21/2013] [Accepted: 07/08/2013] [Indexed: 12/31/2022] Open
Abstract
Spinal subarachnoid hemorrhage (SAH) due to solitary spinal aneurysm is extremely rare. A 45-year-old female patient visited the emergency department with severe headache and back pain. Imaging studies showed cerebral SAH in parietal lobe and spinal SAH in thoracolumbar level. Spinal angiography revealed a small pearl and string-like aneurysm of the Adamkiewicz artery at the T12 level. One month after onset, her back pain aggravated, and follow-up imaging study showed arachnoiditis. Two months after onset, her symptoms improved, and follow-up imaging study showed resolution of SAH. The present case of spinal SAH due to rupture of dissecting aneurysm of the Adamkiewicz artery underwent subsequent spontaneous resolution, indicating that the wait-and-see strategy may provide adequate treatment option.
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Affiliation(s)
- Seong Son
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
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26
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Madhugiri VS, Ambekar S, Roopesh Kumar VR, Sasidharan GM, Nanda A. Spinal aneurysms: clinicoradiological features and management paradigms. J Neurosurg Spine 2013; 19:34-48. [DOI: 10.3171/2013.3.spine121026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Object
Spinal aneurysms (SAs) are rare lesions. The clinicoradiological features and the exact degree of their association with comorbid conditions such as arteriovenous malformations (AVMs) and coarctation of the aorta have not been definitively described. The ideal management paradigm has not been established. The authors reviewed literature to determine the clinical patterns of presentation, management, and outcome of spinal aneurysms.
Methods
A systematic review of literature was performed using 23 separate strings. A total of 10,190 papers were screened to identify 87 papers that met the inclusion criteria. A total of 123 SAs could be included for analysis.
Results
The mean age of patients at presentation was 38 years; 10% of patients were aged less than 10 years and nearly 50% were greater than 38 years. Spinal aneurysms can be divided into 2 groups: those associated with AVMs (SA-AVMs, or Type 1 SAs) and those with isolated aneurysms (iSAs, or Type 2 SAs). Patients with Type 2 SAs were older and more likely to present with bleeding than those with Type 1 SAs. The acute syndromes can be divided into 3 groups of patients: those with spinal syndrome, those with cranial/craniospinal syndrome, and those with nonspecific presentation. Overall, 32.6% presented with angiography-negative cranial subarachnoid hemorrhage (SAH). Presentation with evidence of cord dysfunction (myelopathy/weakness/sensory loss/bladder involvement) correlated with poor outcome, as did presentation with hemorrhage and association with other comorbid conditions. Surgery and endovascular therapy both led to comparable rates of complete aneurysm obliteration for Type 2 SAs, whereas for the AVM-associated Type 1 SAs, surgery led to better rates of lesion obliteration. The authors propose a classification scheme for spinal aneurysms based on whether the lesion is solitary or is associated with a coexistent spinal AVM; this would also imply that the ideal therapy for the aneurysm would differ based on this association.
Conclusions
The clinical and radiological patterns that influence outcome are distinct for Type 1 and Type 2 SAs. The ideal treatment for Type 1 SAs appears to be excision, whereas surgery and endovascular therapy were equally effective for Type 2 SAs.
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Affiliation(s)
- Venkatesh S. Madhugiri
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - Sudheer Ambekar
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - V. R. Roopesh Kumar
- 2Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Gopalakrishnan M. Sasidharan
- 2Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Anil Nanda
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
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27
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Sato K, Roccatagliata L, Depuydt S, Rodesch G. Multiple Aneurysms of Thoracic Spinal Cord Arteries Presenting With Spinal Infarction and Subarachnoid Hemorrhage. Neurosurgery 2012; 71:E1053-8; discussion E1058. [DOI: 10.1227/neu.0b013e3182647be4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Arterial aneurysms of the spinal cord are rare. Their pathogenesis is variable, and the therapeutic strategies remain controversial, because their natural history is unclear. We report a case of multiple dissecting aneurysms of radiculomedullary and radiculopial arteries presenting with spinal infarction and subarachnoid hemorrhage, which spontaneously resolved.
CLINICAL PRESENTATION:
A 67-year-old woman was hospitalized owing to sudden onset of severe back pain with discomfort in the lower extremities. Two days later, she again experienced sudden back pain accompanied by paraparesis and sphincter disturbance. Magnetic resonance imaging of the thoracic spinal cord showed 2 intradural masses of heterogeneous intensity at the levels of T-8 and T-10, spinal infarction, and subarachnoid hemorrhage. Spinal angiography revealed a “pearls and strings” aspect of a radiculomedullary artery arising from the left T-11 and a fusiform aneurysm of a radiculopial artery arising from the left T-8. Infectious and immunological evaluations failed to show any anomaly. Spontaneous dissections were suspected. Conservative treatment was proposed, and the patient's clinical course remained uneventful. Follow-up magnetic resonance imaging and spinal angiography performed 2 months after onset showed disappearance of both arterial lesions.
CONCLUSION:
Arterial dissections of spinal radicular arteries can resolve spontaneously and be managed conservatively. We propose a classification of the pathogenesis of spinal arterial aneurysm to clarify appropriate treatment strategies by a literature review.
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Affiliation(s)
- Kenichi Sato
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Luca Roccatagliata
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France
- Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Genoa, Italy
| | - Sebastien Depuydt
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France
| | - Georges Rodesch
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France
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