title: Ruptured isolated spinal artery aneurysms. Report of two cases and review of the literature.
abstract: Isolated spinal artery aneurysms are exceedingly rare vascular lesions thought to be related to dissection of the arterial wall. We describe two cases presenting with spinal subarachnoid haemorrhage that underwent conservative management. In the first patient the radiculomedullary branch involved was feeding the anterior spinal artery at the level of D3 and thus, neither endovascular nor surgical approach was employed. Control angiography was performed at seven days and at three months, demonstrating complete resolution of the lesion. In our second case, neither the anterior spinal artery or the artery of Adamkiewicz could be identified during angiography, thus endovascular management was deemed contraindicated. Magnetic resonance imaging showed a stable lesion in the second patient. No rebleeding or other complications were seen. In comparison to intracranial aneurysms, spinal artery aneurysms tend to display a fusiform appearance and lack a clear neck in relation to the likely dissecting nature of the lesions. Due to the small number of cases reported, the natural history of these lesions is not well known making it difficult to establish the optimal treatment approach. Various management strategies may be supported, including surgical and endovascular treatment, but It would seem that a wait and see approach is also viable, with control angiogram and treatment decisions based on the evolution of the lesion.
authors.affiliation: Radiology Department, Hospital Clinic i Provincial de Barcelona; Barcelona, Spain - dife85@gmail.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Gutierrez Romero
authors.affiliation: Centre Hospitalier de l'Université de Montréal, Hôpital de Notre-Dame; Montréal, Canada.
authors.forename: Andre Lima
authors.initials: AL
authors.lastname: Batista
authors.affiliation: Centre Hospitalier de l'Université de Montréal, Hôpital de Notre-Dame; Montréal, Canada.
authors.forename: Jean Christoph
authors.initials: JC
authors.lastname: Gentric
authors.affiliation: Centre Hospitalier de l'Université de Montréal, Hôpital de Notre-Dame; Montréal, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Raymond
authors.affiliation: Centre Hospitalier de l'Université de Montréal, Hôpital de Notre-Dame; Montréal, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Roy
authors.affiliation: Centre Hospitalier de l'Université de Montréal, Hôpital de Notre-Dame; Montréal, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Weill
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D003693:Delirium / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D009460:Neurologic Examination; D012075:Remission, Spontaneous; D013116:Spinal Cord / Q000098:blood supply; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000523:psychology / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000523:psychology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D057832:Watchful Waiting
keywords: arterial dissection; spinal aneurysm; spinal artery; spinal subarachnoid haemorrhage