Isolated spinal artery aneurysm: etiology, clinical characteristics, and outcomes

Yuan Zhou Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Tian-Qi Tu Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Jing-Wei Li Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Chuan He Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Ming Ye Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Gui-Lin Li Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Peng Hu Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Li-Yong Sun Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Feng Ling Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Hong-Qi Zhang Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Tao Hong Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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Jia-Xing Yu Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
International Neuroscience Institute (China-INI), Beijing, China

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OBJECTIVE

Isolated spinal aneurysms (ISAs) are rare causes of subarachnoid hemorrhage (SAH), which encompass a highly heterogeneous group of clinical entities with multifarious pathogeneses, clinical characteristics, and treatment strategies. Therefore, knowledge about the ISAs remains inadequate. In this study, the authors present a comprehensive analysis of clinical data associated with ISAs at their institutions to enhance the understanding of this disease.

METHODS

Patients with ISAs confirmed by spinal angiography or surgery at the authors’ institutions between 2015 and 2022 were included. Data regarding clinical presentation, lesion location, aneurysm morphology, comorbidities, treatment results, and clinical outcomes were reviewed.

RESULTS

Seven patients with ISAs were included in the study. Among them, 4 patients (57.1%) experienced severe headache, and 3 patients (42.9%) reported sudden-onset back pain. Additionally, lower-extremity weakness and urinary retention were observed in 2 of these patients (28.6%). Four of the aneurysms exhibited fusiform morphology, whereas the remaining were saccular. All saccular aneurysms in this series were attributed to hemodynamic factors. Conservative treatment was administered to 3 patients, 2 of whom underwent follow-up digital subtraction angiography, which showed spontaneous occlusion of both aneurysms. Four patients ultimately underwent invasive treatments, including 2 who underwent microsurgery and 2 who received endovascular embolization. One patient died of recurrent SAH, while the remaining 6 patients had a favorable prognosis at the latest follow-up assessment.

CONCLUSIONS

The morphology of aneurysms may be associated with their etiology. Saccular ISAs are usually caused by pressure due to abnormally increased blood flow, whereas fusiform lesions may be more likely to be secondary to vessel wall damage. The authors found that a saccular spinal aneurysm in young patients with a significant dilated parent artery may be a vestige of spinal cord arteriovenous shunts. ISAs can be managed by surgical, endovascular, or conservative procedures, and the clinical outcome is generally favorable. However, the heterogeneous nature of the disease necessitates personalized treatment decision-making based on specific clinical features of each patient.

ABBREVIATIONS

ASA = anterior spinal artery; AVS = arteriovenous shunt; DSA = digital subtraction angiography; ISA = isolated spinal aneurysm; mALS = modified Aminoff-Logue scale; mRS = modified Rankin Scale; PSA = posterior spinal artery; RMA = radiculomedullary artery; SAH = subarachnoid hemorrhage.
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