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.
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.
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.
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.
Abbreviations used in this paper:ASA = anterior spinal artery; AVF = arteriovenous fistula; AVM = arteriovenous malformation; CIO = complete and ideal angiographic obliteration; DSA = digital subtraction angiography; iSA = isolated spinal aneurysm; PSA = posterior spinal artery; SA = spinal aneurysm; SAH = subarachnoid hemorrhage.
AounSGSoltanolkotabiMAnsariSAMardenFABatjerHHBendokBR: Ruptured spinal artery aneurysm associated with coarctation of the aorta: case report and literature review. World Neurosurg[epub ahead of print]2012
BaharSCobanOGürvitIHAkman-DemirGGökyiğitA: Spontaneous dissection of the extracranial vertebral artery with spinal subarachnoid haemorrhage in a patient with Behçet's disease. Neuroradiology35:352–3541993
BerlisAScheuflerKMSchmahlCRauerSGötzFSchumacherM: Solitary spinal artery aneurysms as a rare source of spinal subarachnoid hemorrhage: potential etiology and treatment strategy. AJNR Am J Neuroradiol26:405–4102005
BiondiAMerlandJJHodesJEPruvoJPReizineD: Aneurysms of spinal arteries associated with intramedullary arteriovenous malformations. I. Angiographic and clinical aspects. AJNR Am J Neuroradiol13:913–9221992
GuilmetDRosierJRichardTBachetJGoudotBBicalO: [Surgical treatment of thoracic and thoraco-abdominal aneurysms involving the Adamkiewicz's artery. Usefulness of deep hypothermia (author's transl).]. Nouv Presse Med10:3303–33061981. (Fr)
KhooLTTeitelbaumGPStanleyPHieshimaGLevyMLMcCombJG: Familial occurrence of an arteriovenous fistula with a giant perimedullary pseudoaneurysm of the thoracic spinal cord in 2 young siblings. Pediatr Neurosurg28:286–2921998
KuritaMEndoMKitaharaTFujiiK: Subarachnoid haemorrhage due to a lateral spinal artery aneurysm misdiagnosed as a posterior inferior cerebellar artery aneurysm: case report and literature review. Acta Neurochir (Wien)151:165–1692009
LiberatiAAltmanDGTetzlaffJMulrowCGøtzschePCIoannidisJPA: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ339:b27002009
SatoKRoccatagliataLDepuydtSRodeschG: Multiple aneurysms of thoracic spinal cord arteries presenting with spinal infarction and subarachnoid hemorrhage: case report and literature review. Neurosurgery71:E1053–E10582012