A Case of Coil Embolization for a Ruptured Anterior Spinal Artery Aneurysm Associated with Bilateral Vertebral Artery Occlusion

Abstract

Anterior spinal artery (ASA) aneurysms are rare, and the majority are associated with vascular lesions such as arteriovenous malformations, moyamoya disease, and aortic stenosis. Herein, we report a case of a ruptured anterior spinal artery aneurysm caused by bilateral vertebral artery (VA) occlusion, which was treated by coil embolization. An 83-year-old man was found collapsed at home, and was brought in by emergency. His consciousness level was I-1 on the Japan Coma Scale, and there were no symptoms such as paralysis in the extremities. Computed tomography showed Fisher 3 subarachnoid hemorrhage, while magnetic resonance angiography showed an aneurysm in the right VA. Digital subtraction angiography showed bilateral VA occlusion, and an aneurysm was found on the dilated ASA as a collateral circulation. Coil embolization was performed after confirmation of no hemodynamic problems. No postoperative adverse events were observed. Coil embolization may be an effective treatment for ruptured aneurysms of the ASA.

Clip Ligation and Disconnection of a Ruptured Ventral Subaxial Cervical Isolated Spinal Aneurysm Using Tailored Access Osteotomies: An Operative Technique

“…30 The redundant VPP nature links pial branches of nearby RMAs, making endovascular embolization of RPAs safer, although not without risk. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]30 Microsurgical RPA occlusion is safe in principle, although distinguishing a vRPA from an RMA branch can be difficult in practice. As such, treatment of SAs through the ventral access is typically reported as endovascular embolization or diversion, with aneurysms associated with AVFs and AVMs commonly reported owing to prevalence and the hypertrophied, high-flow state of involved vasculature.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Rupture carries a high rate of morbidity, typically through acute spinal cord injury. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Treatment strategies feature conservative, endovascular, open, and multimodal options. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] iSAs of the ventral spinal axis, particularly around the cervical enlargement, are often managed by conservative measures secondary to small vessel caliber, eloquent angioarchitecture, and inaccessible anatomy.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Treatment strategies feature conservative, endovascular, open, and multimodal options. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] iSAs of the ventral spinal axis, particularly around the cervical enlargement, are often managed by conservative measures secondary to small vessel caliber, eloquent angioarchitecture, and inaccessible anatomy. 3,4,6,9,11,13,[16][17][18][19][20][21][22][23] Surgical and endovascular options are limited by safe access, typically for iSAs located distal to the cervical enlargement, where large caliber vessels and increased working room make conditions more favorable.…”

“…solated spinal aneurysms (iSAs) are generally fusiform lesions of the spinal vasculature with no associated vascular malformation which typically present ruptured as spontaneous subarachnoid hemorrhage (sSAH) along small vessel segments, affecting the anterior spinal artery (ASA), segmental radiculomedullary (RMA), or ventral radiculopial (vRPA) arteries in over 75% of cases. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Rupture carries a high rate of morbidity, typically through acute spinal cord injury. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Treatment strategies feature conservative, endovascular, open, and multimodal options.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] iSAs of the ventral spinal axis, particularly around the cervical enlargement, are often managed by conservative measures secondary to small vessel caliber, eloquent angioarchitecture, and inaccessible anatomy. 3,4,6,9,11,13,[16][17][18][19][20][21][22][23] Surgical and endovascular options are limited by safe access, typically for iSAs located distal to the cervical enlargement, where large caliber vessels and increased working room make conditions more favorable. [24][25][26] Described open treatment for iSAs of the ventral axis of the subaxial cervical spine is limited to case reports and series.…”