Ruptured Spinal Aneurysms: Diagnosis and Management Paradigms

Area of Science:

• Neuroscience
• Vascular Surgery
• Radiology

Background:

• Spinal aneurysms (SA) are uncommon neurovascular conditions with poorly understood natural history and treatment guidelines.
• This study reviews the clinical, radiological, and management aspects of patients with spinal subarachnoid hemorrhage (SAH) caused by ruptured spinal aneurysms over a decade.

Observation:

• Ten patients with non-traumatic spinal SAH were identified between 2010 and 2020.
• Four cases of spinal aneurysms were diagnosed as the cause of SAH, predominantly in the cervical region.
• Aneurysms involved the anterior spinal artery or radiculomedullary arteries; one was flow-related, and three were idiopathic pseudoaneurysms.

Findings:

• One flow-related aneurysm treated surgically had a good outcome.
• Conservative management of pseudoaneurysms yielded mixed results, with one fatality due to vasospasm.
• Two aneurysms resolved spontaneously on angiography, and one appeared on follow-up imaging.

Implications:

• Spinal aneurysms should be considered in cases of spinal and/or posterior fossa SAH.
• Conservative management is a viable option, and repeat spinal angiography is recommended before intervention due to potential spontaneous resolution.