Multiple isolated spinal aneurysms – A rare condition with uncertain treatment strategies: A case report and literature review
Purpose: Isolated spinal aneurysms (iSAs) are rare, with an uncertain natural history and no established treatment guidelines. Multiple iSAs are even more uncommon, complicating treatment decisions. Methods: This study reports a case of a ruptured radiculo-pial artery aneurysm in a patient with mult...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425000116 |
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| author | F.M.C. Lioi D. Dahlberg J. Sundseth K.B. Olsen H.L. Lilleby B. Nedregaard M.K.H. Wiedmann |
| author_facet | F.M.C. Lioi D. Dahlberg J. Sundseth K.B. Olsen H.L. Lilleby B. Nedregaard M.K.H. Wiedmann |
| author_sort | F.M.C. Lioi |
| collection | DOAJ |
| description | Purpose: Isolated spinal aneurysms (iSAs) are rare, with an uncertain natural history and no established treatment guidelines. Multiple iSAs are even more uncommon, complicating treatment decisions. Methods: This study reports a case of a ruptured radiculo-pial artery aneurysm in a patient with multiple iSAs, treated with surgical excision, assisted by intraoperative neurophysiological monitoring (IONM). Further, we review and analyze all previously reported cases of multiple iSAs. Results: A 67-year-old woman with spinal subarachnoid hemorrhage and spinal cord compression due to a ruptured radiculo-pial artery aneurysm was treated surgically. Digital subtraction angiography (DSA) showed three spinal aneurysms. Intraoperative indocyanine green video-angiography (ICG-VA) revealed an aneurysm contributing to the left posterior spinal artery. The aneurysm was excised after proximal inflow occlusion under IONM. The other aneurysms spontaneously regressed, and the patient had a good functional outcome. Through a systematic literature review, we analyzed 13 multiple iSAs including our case, involving 34 aneurysms in total. Conclusions: There is no standardized treatment approach for multiple iSAs. These aneurysms are often fusiform and clustered in contiguous metameric regions. They can be classified into flow-related and wall-weakening aneurysms. Surgery offers definitive treatment for ruptured iSAs and relieves spinal cord compression. Due to the common fusiform shape, parent vessel sacrifice may be necessary, and should include IONM and ICG-VA to minimize complications. Conservative treatment is viable as spontaneous regression often occurs. |
| format | Article |
| id | doaj-art-0f11dadbadf74567b9282c57c04abb9e |
| institution | Kabale University |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-0f11dadbadf74567b9282c57c04abb9e2025-01-26T05:05:22ZengElsevierBrain and Spine2772-52942025-01-015104192Multiple isolated spinal aneurysms – A rare condition with uncertain treatment strategies: A case report and literature reviewF.M.C. Lioi0D. Dahlberg1J. Sundseth2K.B. Olsen3H.L. Lilleby4B. Nedregaard5M.K.H. Wiedmann6Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, ItalyDepartment of Neurosurgery, Oslo University Hospital, Oslo, NorwayDepartment of Neurosurgery, Oslo University Hospital, Oslo, NorwayDepartment of Neurosurgery, Oslo University Hospital, Oslo, NorwayDepartment of Pathology, Oslo University Hospital, Oslo, NorwayDepartment of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, NorwayDepartment of Neurosurgery, Oslo University Hospital, Oslo, Norway; Corresponding author.Purpose: Isolated spinal aneurysms (iSAs) are rare, with an uncertain natural history and no established treatment guidelines. Multiple iSAs are even more uncommon, complicating treatment decisions. Methods: This study reports a case of a ruptured radiculo-pial artery aneurysm in a patient with multiple iSAs, treated with surgical excision, assisted by intraoperative neurophysiological monitoring (IONM). Further, we review and analyze all previously reported cases of multiple iSAs. Results: A 67-year-old woman with spinal subarachnoid hemorrhage and spinal cord compression due to a ruptured radiculo-pial artery aneurysm was treated surgically. Digital subtraction angiography (DSA) showed three spinal aneurysms. Intraoperative indocyanine green video-angiography (ICG-VA) revealed an aneurysm contributing to the left posterior spinal artery. The aneurysm was excised after proximal inflow occlusion under IONM. The other aneurysms spontaneously regressed, and the patient had a good functional outcome. Through a systematic literature review, we analyzed 13 multiple iSAs including our case, involving 34 aneurysms in total. Conclusions: There is no standardized treatment approach for multiple iSAs. These aneurysms are often fusiform and clustered in contiguous metameric regions. They can be classified into flow-related and wall-weakening aneurysms. Surgery offers definitive treatment for ruptured iSAs and relieves spinal cord compression. Due to the common fusiform shape, parent vessel sacrifice may be necessary, and should include IONM and ICG-VA to minimize complications. Conservative treatment is viable as spontaneous regression often occurs.http://www.sciencedirect.com/science/article/pii/S2772529425000116SpineAneurysmHematomaHemorrhageVascular malformationTreatment |
| spellingShingle | F.M.C. Lioi D. Dahlberg J. Sundseth K.B. Olsen H.L. Lilleby B. Nedregaard M.K.H. Wiedmann Multiple isolated spinal aneurysms – A rare condition with uncertain treatment strategies: A case report and literature review Brain and Spine Spine Aneurysm Hematoma Hemorrhage Vascular malformation Treatment |
| title | Multiple isolated spinal aneurysms – A rare condition with uncertain treatment strategies: A case report and literature review |
| title_full | Multiple isolated spinal aneurysms – A rare condition with uncertain treatment strategies: A case report and literature review |
| title_fullStr | Multiple isolated spinal aneurysms – A rare condition with uncertain treatment strategies: A case report and literature review |
| title_full_unstemmed | Multiple isolated spinal aneurysms – A rare condition with uncertain treatment strategies: A case report and literature review |
| title_short | Multiple isolated spinal aneurysms – A rare condition with uncertain treatment strategies: A case report and literature review |
| title_sort | multiple isolated spinal aneurysms a rare condition with uncertain treatment strategies a case report and literature review |
| topic | Spine Aneurysm Hematoma Hemorrhage Vascular malformation Treatment |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425000116 |
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