Neurointervention.  2024 Nov;19(3):190-193. 10.5469/neuroint.2024.00311.

Coil Embolization of a Ruptured Anterior Spinal Artery Aneurysm Associated with Spinal Cord Arteriovenous Malformation

• Ioannidis I
• Kalogeras A
• Tasiou A
• Vlychou M
• Fountas KN

• KMID: 2560225
• DOI: http://doi.org/10.5469/neuroint.2024.00311

Abstract

The present report describes a patient with spinal cord arteriovenous malformation (AVM) and an associated anterior spinal artery aneurysm presenting with subarachnoid hemorrhage. Diagnostic spinal angiography revealed an intramedullary AVM, located at the T10–T11 level, and a prenidal saccular aneurysm at the junction of the radiculomedullary artery and the anterior spinal axis, fed by the right T8 segmental artery. The patient underwent successful selective coil embolization of the aneurysm. Follow-up angiography 3 months postoperatively showed no recurrence of the aneurysm.

Keyword

Anterior spinal artery; Aneurysm; Subarachnoid hemorrhage; Endovascular treatment

Figure

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  Fig. 1. Cerebral computed tomography scan on admission showed subarachnoid hemorrhage with intraventricular extension (A). Spinal cord digital subtraction angiography showed (B) an intramedullary arteriovenous malformation, at the T10–T11 level, supplied mostly by the anterior spinal artery. Immediate post-embolization angiography (C) showed complete occlusion of the aneurysm. Follow-up angiogram (D) 6 months post embolization showed no recurrence of the aneurysm.

Reference

1. Biondi A, Merland JJ, Hodes JE, Pruvo JP, Reizine D. Aneurysms of spinal arteries associated with intramedullary arteriovenous malformations. I. Angiographic and clinical aspects. AJNR Am J Neuroradiol. 1992; 13(3):913–922.

2. Chen CC, Bellon RJ, Ogilvy CS, Putman CM. Aneurysms of the lateral spinal artery: report of two cases. Neurosurgery. 2001; 48:949–953. discussion 953-954.

3. Konan AV, Raymond J, Roy D. Transarterial embolization of aneurysms associated with spinal cord arteriovenous malformations. Report of four cases. J Neurosurg. 1999; 90(1 Suppl):148–154.

4. Lavoie P, Raymond J, Roy D, Guilbert F, Weill A. Selective treatment of an anterior spinal artery aneurysm with endosaccular coil therapy. Case report. J Neurosurg Spine. 2007; 6:460–464.

5. Djindjian R. Angiography of the spinal cord. Surg Neurol. 1974; 2:179–185.

6. Madhugiri VS, Ambekar S, Roopesh Kumar VR, Sasidharan GM, Nanda A. Spinal aneurysms: clinicoradiological features and management paradigms. J Neurosurg Spine. 2013; 19:34–48.

7. Abdalkader M, Samuelsen BT, Moore JM, Cervantes-Arslanian A, Ong CJ, Setty BN, et al. Ruptured spinal aneurysms: diagnosis and management paradigms. World Neurosurg. 2021; 146:e368–e377.

8. van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet. 2007; 369:306–318.

9. Jung SC, Song Y, Cho SH, Kim J, Noh SY, Lee SH, et al. Endovascular management of aneurysms associated with spinal arteriovenous malformations. J Neurointerv Surg. 2018; 10:198–203.

10. Baldassarre B, Balestrino A, D’Andrea A, Anania P, Ceraudo M, Truffelli M, et al. Management of spinal aneurysms associated with arteriovenous malformations: systematic literature review and illustrative case. Eur Spine J. 2021; 30:2767–2774.

11. Yamazaki D, Hanaoka Y, Koyama JI, Suzuki Y, Agata M, Abe D, et al. Intraspinal canal platform system for coil embolization of anterior spinal artery aneurysm associated with spinal cord arteriovenous malformation: a case report and literature review. Br J Neurosurg. 2023; 37:1786–1791.

12. Ren Y, He M, You C, Li J. Successful surgical resection of spinal artery aneurysms: report of 3 cases. World Neurosurg. 2018; 109:171–178.

13. Scoville WB. Intramedullary arteriovenous aneurysm of the spinal cord; case report with operative removal from the conus medullaris. J Neurosurg. 1948; 5:307–312.

14. Binder B, Eng GD, Milhorat TH, Galioto F. Spinal arteriovenous malformations in an infant: unusual symptomology and pathology. Dev Med Child Neurol. 1982; 24:380–385.

15. Zhang HJ, Silva N, Solli E, Ayala AC, Tomycz L, Christie C, et al. Treatment options and long-term outcomes in pediatric spinal cord vascular malformations: a case report and review of the literature. Childs Nerv Syst. 2020; 36:3147–3152.

16. Caroscio JT, Brannan T, Budabin M, Huang YP, Yahr MD. Subarachnoid hemorrhage secondary to spinal arteriovenous malformation and aneurysm. Report of a case and review of the literature. Arch Neurol. 1980; 37:101–103.