Spinal aneurysms: clinicoradiological features and management paradigms

A systematic review

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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.

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.

Article Information

Address correspondence to: Anil Nanda, M.D., M.P.H., Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103. email: ananda@lsuhsc.edu.

Please include this information when citing this paper: published online April 26, 2013; DOI: 10.3171/2013.3.SPINE121026.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Search tree showing the strategy for selecting articles for the review and the number of articles screened at each stage.

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    Bar graph demonstrating the correlation between age and the association of SAs with AVMs. Values on the y axis represent the number of SAs. Blue bars represent SA-AVMs, and green bars, iSAs.

  • View in gallery

    Bar graph displaying the age-wise distribution of patients who presented with hemorrhage (blue bars) from SAs versus those who did not (green bars). Values on the y axis represent the number of SAs.

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