A Ruptured Aneurysm in the Branch of the Anterior Spinal Artery

Abstract

Incidence of aneurysm of the anterior spinal artery is known to be very low and the standard treatment strategy has not yet been established. The author experienced a case of subarachnoid hemorrhage (SAH) caused by the rupture of an aneurysm in the branch of the cervical anterior spinal artery, which was managed conservatively. The patient had end-stage common bile duct cancer and survived for 103 days after onset of the SAH without a re-rupture of the aneurysm.

Dissecting spinal aneurysms: conservative management as a therapeutic option

“…Yang reported a ruptured aneurysm in the cervical segment of the ASA that was treated conservatively with no rebleed until the last clinical follow-up. This patient had a history of advanced stage cancer and did not have angiographic follow-up, therefore occlusion of the lesion could not be assessed 12. A similar case was reported by Nahkla et al , where a ruptured cervical ASA aneurysm was diagnosed in an elderly patient (aged 88 years) in whom conservative management was adopted 6.…”

Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage

“…[ 1 2 ] The main hypothesis points to inflammatory, infectious, and connective tissue diseases. [ 6 7 8 ] Traumatic events leading to arterial dissection and formation of pseudoaneurysms may play a role, although the exact mechanism is not clearly understood. There is also an association with arteriovenous malformations.…”

“…Angiography provides detailed information on aneurysm shape, size, direction, and location. [ 6 7 8 ]…”

“…Although controversy persists, the current experience suggests that surgical or endovascular treatment are the preferred strategies. [ 1 2 3 4 5 6 7 8 ] In surgical cases, suboccipital and far lateral approaches are recommended for aneurysm clipping or trapping[ 1 3 ]. Anterior cervical corpectomy is not encouraged.…”

“…Isolated cervical anterior spinal artery (ASA) aneurysms are extremely rare. [ 1 2 3 4 5 6 7 8 ] To the best of our knowledge, subarachnoid hemorrhage (SAH) secondary to such lesions has been described only in six cases. [ 6 7 8 ]…”