Spinal aneurysms: clinicoradiological features and management paradigms

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Spinal aneurysms (SAs) are rare lesions. The clinicoradiological features and the exact degree of their association with comorbid conditions such as arteriovenous malformations (AVMs) and coarctation of the aorta have not been definitively described. The ideal management paradigm has not been established. The authors reviewed literature to determine the clinical patterns of presentation, management, and outcome of spinal aneurysms.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A systematic review of literature was performed using 23 separate strings. A total of 10,190 papers were screened to identify 87 papers that met the inclusion criteria. A total of 123 SAs could be included for analysis.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The mean age of patients at presentation was 38 years; 10% of patients were aged less than 10 years and nearly 50% were greater than 38 years. Spinal aneurysms can be divided into 2 groups: those associated with AVMs (SA-AVMs, or Type 1 SAs) and those with isolated aneurysms (iSAs, or Type 2 SAs). Patients with Type 2 SAs were older and more likely to present with bleeding than those with Type 1 SAs. The acute syndromes can be divided into 3 groups of patients: those with spinal syndrome, those with cranial/craniospinal syndrome, and those with nonspecific presentation. Overall, 32.6% presented with angiography-negative cranial subarachnoid hemorrhage (SAH). Presentation with evidence of cord dysfunction (myelopathy/weakness/sensory loss/bladder involvement) correlated with poor outcome, as did presentation with hemorrhage and association with other comorbid conditions. Surgery and endovascular therapy both led to comparable rates of complete aneurysm obliteration for Type 2 SAs, whereas for the AVM-associated Type 1 SAs, surgery led to better rates of lesion obliteration. The authors propose a classification scheme for spinal aneurysms based on whether the lesion is solitary or is associated with a coexistent spinal AVM; this would also imply that the ideal therapy for the aneurysm would differ based on this association.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The clinical and radiological patterns that influence outcome are distinct for Type 1 and Type 2 SAs. The ideal treatment for Type 1 SAs appears to be excision, whereas surgery and endovascular therapy were equally effective for Type 2 SAs.</jats:p></jats:sec>

Endovascular management of aneurysms associated with spinal arteriovenous malformations

“…The incidence of aneurysms could not be compared with other studies because only case reports or series including 1–4 cases have been published. A systematic review on spinal aneurysms showed that 55 (44.7%) were associated with an AVM and 68 (55.3%) were isolated spinal aneurysms not associated with an AVM; thus, isolated aneurysms are more commonly associated with SAVM 4. However, we did not observe any isolated spinal aneurysms in our study or any aneurysm associated with an epidural arteriovenous fistula, which is known to cause congestive venous myelopathy 14–17…”

“…Therefore, our study showed that hemorrhage of a spinal aneurysm was less common than reported in the literature. Aneurysms in our study were relatively common (4/8) in cervical cord areas, as found in a systemic review 4. Although we did not use surgical decompression to relieve the mass effect, there are several reports on surgical decompression or clipping of the feeding artery ligation 21 22…”

“…In the study of Madhugiri et al , in which 20.8% of the spinal aneurysms were associated with SAVM and 7.8% with isolated spinal aneurysms, patients presented with complaints not attributable to bleeding from the lesion 4. Therefore, our study showed that hemorrhage of a spinal aneurysm was less common than reported in the literature.…”

“…About 8% (9 out of 112) of aneurysms underwent spontaneous regression 4. None of them had an associated AVM; all had presented with hemorrhage.…”

Spinal artery aneurysms: clinical presentation, radiological findings and outcome

“…In our series, these patient populations comprised nearly 40% of cases. Transplant has also been tied to isolated spinal arterial aneurysms as approximately 6% of patients in one systematic review were post-renal transplant 1. In our series, one patient presented post-cardiac transplant.…”