Maiti Tanmoy K, Bir Shyamal C, Nanda Anil
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Handb Clin Neurol. 2017;143:215-223. doi: 10.1016/B978-0-444-63640-9.00020-5.
Spinal subarachnoid hemorrhage (SAH) is a rare disease. Spinal aneurysms are even rarer and mostly undetected unless they rupture and become symptomatic. In this chapter we aim to review the available literature about spinal subarachnoid hematoma with special emphasis on spinal aneurysms. As most reports of spinal aneurysms describe a single case or a small case series, the diagnostic algorithm is often lacking. The outcome is also different based on the etiologies; therefore management strategy must be individualized. We addressed these issues in this chapter. The reported incidence of spinal SAH is less than epidural hematoma and more than subdural hematoma. Spinal aneurysms can present as isolated entity or can be associated with other vascular anomalies. Microsurgical clipping and/or resection is possible, especially when they are located dorsally or dorsolaterally. Endovascular approach is also a feasible option unless negotiation of microcatheter becomes difficult in tortuous small-caliber arteries. Successful obliteration leads to good outcome, especially when present in posterior spinal artery. A detailed knowledge of spinal SAH and spinal aneurysms is important to detect them in time. Clinicians must consider several factors to choose an appropriate treatment strategy to ensure the safety of their patients.
脊髓蛛网膜下腔出血（SAH）是一种罕见疾病。脊髓动脉瘤更为罕见，大多未被发现，除非破裂并出现症状。在本章中，我们旨在回顾有关脊髓蛛网膜下腔血肿的现有文献，特别强调脊髓动脉瘤。由于大多数脊髓动脉瘤的报告描述的是单个病例或小病例系列，因此通常缺乏诊断算法。根据病因不同，结果也有所不同；因此，管理策略必须个体化。我们在本章中讨论了这些问题。报告的脊髓SAH发病率低于硬膜外血肿，高于硬膜下血肿。脊髓动脉瘤可表现为孤立实体，也可与其他血管异常相关。显微手术夹闭和/或切除是可行的，尤其是当它们位于背侧或背外侧时。血管内介入也是一种可行的选择，除非在迂曲的小口径动脉中微导管难以通过。成功闭塞可带来良好的结果，尤其是当存在于脊髓后动脉时。详细了解脊髓SAH和脊髓动脉瘤对于及时发现它们很重要。临床医生必须考虑几个因素来选择合适的治疗策略，以确保患者的安全。
