Ruptured Isolated Aneurysm of a Coronal Branch of the Anterior Spinal Artery: Case Report and Discussion of Treatment Strategies

Clip Ligation and Disconnection of a Ruptured Ventral Subaxial Cervical Isolated Spinal Aneurysm Using Tailored Access Osteotomies: An Operative Technique

“…[30][31][32][33][34][35][36][37][38][39][40][41][42][43] iSA of the subaxial cervical spine is a highly morbid pathology addressed by individualized strategies. 6,9 Treatment is dictated by angioarchitecture and accessibility, intimately tied to segmental arterial anatomy [6][7][8][9][10] (Figure 4). Within the cervical spine, 2 to 4 radicular arteries variably branch into the RMA, dorsal and vRPA, or any combination thereof, the former coursing toward the midline before dividing into ascending and descending branches supplying the ASA 7,30 (Figure 4).…”

“…6,9 Most cases involving ventral lesions are managed conservatively owing to the perceived risk of severe infarct, and operative inaccessibility along with relatively stable clinical conditions on presentation. 6,9 When treatment is undertaken, at least partial recovery has been reported in 80% to 90% of cases. 6,9 The patient discussed presented with a complete spinal injury secondary to a ruptured iSA with clearly delineated angioarchitecture centered on pial vessels.…”

“…6,9 When treatment is undertaken, at least partial recovery has been reported in 80% to 90% of cases. 6,9 The patient discussed presented with a complete spinal injury secondary to a ruptured iSA with clearly delineated angioarchitecture centered on pial vessels. The goal of the treatment was to prevent further decline secondary to rerupture or stroke.…”

“…30 The redundant VPP nature links pial branches of nearby RMAs, making endovascular embolization of RPAs safer, although not without risk. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]30 Microsurgical RPA occlusion is safe in principle, although distinguishing a vRPA from an RMA branch can be difficult in practice. As such, treatment of SAs through the ventral access is typically reported as endovascular embolization or diversion, with aneurysms associated with AVFs and AVMs commonly reported owing to prevalence and the hypertrophied, high-flow state of involved vasculature.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] iSAs of the ventral spinal axis, particularly around the cervical enlargement, are often managed by conservative measures secondary to small vessel caliber, eloquent angioarchitecture, and inaccessible anatomy. 3,4,6,9,11,13,[16][17][18][19][20][21][22][23] Surgical and endovascular options are limited by safe access, typically for iSAs located distal to the cervical enlargement, where large caliber vessels and increased working room make conditions more favorable. [24][25][26] Described open treatment for iSAs of the ventral axis of the subaxial cervical spine is limited to case reports and series.…”