J Cerebrovasc Endovasc Neurosurg.  2017 Sep;19(3):217-222. 10.7461/jcen.2017.19.3.217.

Surgical Removal of a Ruptured Radiculomedullary Artery Aneurysm: A Case Report

• Kim SB
• Ban SP
• Kim HJ
• Kwon OK

• KMID: 2393506
• DOI: http://doi.org/10.7461/jcen.2017.19.3.217

Abstract

Subarachnoid hemorrhage due to a solitary spinal aneurysm is extremely rare, and diagnosis and treatment are challenging. We report a rare case of a ruptured radiculomedullary artery aneurysm in a patient with Behçet disease. A 49-year-old man presented with severe lower abdominal and leg pain. Magnetic resonance imaging was performed and an enhanced intradural-extramedullary lesion at the T12 spinal level with subarachnoid hemorrhage was identified. Diagnostic spinal angiography was performed to evaluate the vascular lesion, and a radiculomedullary artery aneurysm at the T12 level was identified. We performed surgical resection of the aneurysm and a good neurological outcome was obtained.

Keyword

Spinal aneurysm; Radiculomedullary artery; Subarachnoid hemorrhage

MeSH Terms

Aneurysm*
Angiography
Arteries*
Behcet Syndrome
Diagnosis
Humans
Leg
Magnetic Resonance Imaging
Middle Aged
Subarachnoid Hemorrhage

Figure

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  Fig. 1 A nodular lesion (arrow) with iso-intense signal on T1-weighted images (A) and hyper-intense signal on T2-weighted images (B). On enhanced T1-weighted images (C), the nodular lesion was enhanced at the T12 level.

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  Fig. 2 (A), (B) Selective spinal angiogram showing the fusiform aneurysm (arrow) on the right L2 radiculomedullary artery at the T12 level.

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  Fig. 3 Intraoperative photograph showing the aneurysm (arrow).

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  Fig. 4 Photomicrographs of the resected aneurysmal wall. (A) The section shows mild fibrosis in the degenerated vascular wall (Masson trichrome stain, ×200). (B) Thin elastic fibers in the vascular wall are demonstrated (Elastica von Giesen stain, ×200).

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