Iwata Takashi, Aihara Noritaka, Ohno Takayuki, Shibata Hiromi, Ishida Motoki, Shogaku Misa
Department of Neurosurgery, Nagoya City University East Medical Center, Nagoya, Japan.
Surg Neurol Int. 2025 Apr 4;16:121. doi: 10.25259/SNI_1080_2024. eCollection 2025.
Isolated spinal aneurysms (ISAs) represent a rare etiology of subarachnoid hemorrhage (SAH). There are very few published reports of the rupture of an ISA, which has led to ongoing debate regarding the optimal therapeutic approach. We report a rare case of an isolated radiculomedullary artery aneurysm associated with SAH. Endovascular treatment was attempted but was unsuccessful. However, imaging confirmed that the aneurysm thrombosed relatively early following the procedure.
A 59-year-old woman presented with a sudden headache and vomiting. Head computed tomography showed SAH with a thick hematoma in the posterior fossa. Initial angiography could not detect the source of bleeding, but follow-up angiography revealed an aneurysm ventral to the C5 spinal cord. Endovascular embolization was attempted but was terminated without placing embolizing material due to difficulty in guiding the microcatheter. Thrombus and shrinkage were observed on follow-up imaging, and complete occlusion of the aneurysm was observed on angiography.
Although rare, manipulation during endovascular therapy likely caused thrombus formation, leading to occlusion of the aneurysm. Therefore, postoperative imaging follow-up is important even in cases of unsuccessful endovascular treatment.
孤立性脊髓动脉瘤（ISA）是蛛网膜下腔出血（SAH）的一种罕见病因。关于ISA破裂的报道极少，这导致了关于最佳治疗方法的持续争论。我们报告一例与SAH相关的罕见孤立性神经根髓动脉动脉瘤病例。尝试了血管内治疗但未成功。然而，影像学证实动脉瘤在手术后相对早期形成血栓。
一名59岁女性突发头痛和呕吐。头部计算机断层扫描显示SAH伴后颅窝厚血肿。初次血管造影未检测到出血源，但随访血管造影显示C5脊髓腹侧有一个动脉瘤。尝试进行血管内栓塞，但由于微导管引导困难，未放置栓塞材料即终止操作。随访影像学观察到血栓形成和动脉瘤缩小，血管造影显示动脉瘤完全闭塞。
尽管罕见，但血管内治疗过程中的操作可能导致血栓形成，从而导致动脉瘤闭塞。因此，即使血管内治疗未成功，术后影像学随访也很重要。
