Diagnostic and Therapeutic Approaches for Spinal Subarachnoid Hemorrhage Due to Spinal Aneurysms and Other Etiologies.

: Spinal subarachnoid hemorrhage (sSAH) is a very rare disease. Detailed information about the natural course, pathogenesis, radiological manifestation, and therapeutic management is lacking. This study aimed to analyze patients diagnosed with sSAH, focusing on the origin, management strategies, and therapeutic approaches to sSAH. : The study included a cohort of patients admitted to the Department of Neurosurgery, LMU University Hospital, LMU Munich, between January 2021 and December 2024 with a confirmed diagnosis of spinal subarachnoid hemorrhage and, among other things, spinal aneurysms. Data on the included patients were recorded with emphasis on demographics, radiological examination (CT, MRI, and DSA), aneurysm-specific characteristics, and clinical outcome. : The study included six patients diagnosed with spinal subarachnoid hemorrhage via multimodal imaging. The etiology of sSAH was identified in all cases, encompassing spinal aneurysms in three patients, anticoagulation therapy in two cases, and bony microspurs in one case, with management strategies tailored as either conservative (monitoring and imaging) or surgical (aneurysm resection, arterial feeder coagulation, or evacuation of intraspinal bleeding). No major adverse events were observed, and all the patients demonstrated neurological improvement or exhibited only mild-to-moderate disability during follow-up. : Spinal subarachnoid hemorrhage can be due to a ruptured spinal aneurysm, but in some cases, other underlying causes should be considered as the source of the hemorrhage. Given the scarcity of literature on this condition, it is crucial to identify the correct diagnosis and implement a patient-tailored therapeutic approach.