Article
Solitary aneurysms of the posterior spinal artery as cause of intraspinal subarachnoid haemorrhage
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Authors
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M.F. Oertel
- Universitätsklinik für Neurochirurgie, Inselspital, Universität Bern, Bern, Schweiz; Neurochirurgische Klinik, Universitätsklinikum, RWTH Aachen, Aachen, Deutschland
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S. Geibprasert
- Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Canada
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T. Krings
- Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Canada
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F.J. Hans
- Neurochirurgische Klinik, Universitätsklinikum, RWTH Aachen, Aachen, Deutschland
| Published: | June 4, 2012 |
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Outline
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Objective: Intrapinal SAH is rare and mainly caused by rupture of SCAVM or highly vasculated tumours. Aneurysms arising from spinal arteries are extremely rare being usually flow related aneurysms associated with SCAVM, DAVF, aortic coarctation, bilateral vertebral occlusion, and moyamoya disease. Isolated dissecting spinal cord aneurysms are exceptional. Therefore, based on the description of two unique cases of spinal SAH following rupture of isolated radiculopial artery aneurysms, the authors present related diagnostic strategies and discuss possible treatment options.
Methods: A 72-year-old woman presented with SAH due to a radiculopial aneurysm arising from the left L2 segmental artery. Successful endovascular occlusion was performed via coil occlusion of the parent artery. A 43-year-old man was admitted with SAH after minor trauma and rupture of a posterior spinal artery aneurysm originating from the right T4 level. Endovascular treatment was not contemplated because of the small size of the feeding artery, whereas microsurgical resection was deemed more appropriate because of the posterolateral perimedullary location that was well appreciated on CT angiography.
Results: Two different cases of spinal SAH caused by solitary dissecting aneurysms of the posterior spinal artery were presented. Pretreatment spinal angiography, MRI, and CT were performed to choose the potential best treatment modality. During a short hospital stay, both patients showed complete clinical recovery, and follow-up neuroimaging confirmed stable occlusion of both aneuryms.
Conclusions: Exceptionally rare, intraspinal SAH is caused by isolated posterior artery aneurysms. Because of the associated high rebleeding and mortality rates of these kinds of aneurysms the possibility of their coincidence with SAH should be considered and prompt adequate therapy is mandatory. Although the definite diagnosis requires spinal angiography, MRI and CT can better delineate the anatomical relationship of the aneurysms to the spinal cord in order to determine the best treatment strategy.
