Cervicomedullary Region Spinal Artery Aneurysms: Report of Seven Cases with Review of Etiology and Management Strategies

Introduction: Spinal artery aneurysms in the cervicomedullary region are very rare, limited to single case reports in the literature. They can be associated with pathology that increases hemodynamic stress (such as AVMs or aortic coarctation), alter the blood vessel wall (infectious or inflammatory processes) or in isolation. They occur most commonly in the thoracic spine. When they are a cause of intracranial subarachnoid hemorrhage, their diagnosis is often missed as they are rarely encountered in clinical practice. We report our experience with a series of seven patients with this unique pathology.

Methods: The inpatient and outpatient charts of patients at a single institution between 2001 and 2018 harboring spinal artery aneurysms of the cervicomedullary junction were retrospectively reviewed. Patient age, comorbidities, aneurysm size and morphology, treatment, and outcome were analyzed.

Results: A total of seven cases were reviewed and included in the study. Mean age was 51 years of age with six female patients and one male. Of the seven cases, four (57%) were fusiform, one was saccular (14%), and two (29%) were associated with afferent AVM vessels. Aneurysm size ranged from 1 to 10 mm. When treated, dissecting aneurysms were treated with clip wrapping and AVM associated were treated by embolization of the aneurysm with surgery for definitive treatment of the spinal cord AVM. Three of seven (43%) aneurysms had an identifiable cause for increased hemodynamic demand through the parent vessel.

Conclusion: Spinal artery aneurysms of the cervicomedullary region are a rare cause of intracranial subarachnoid hemorrhage. Their presence should be considered in the setting of otherwise angiogram negative subarachnoid hemorrhage with the majority of the blood in the posterior fossa or craniocervical junction.