gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Case report of a massive spinal hemorrhage due to ruptured spinal aneurysm and coincidental cerebral AVM

Meeting Abstract

  • L. Füllbier - Neurochirurgische Klinik des Klinikums Stuttgart
  • H. Henkes - Neuroradiologische Klinik des Klinikums Stuttgart
  • N. Hopf - Neurochirurgische Klinik des Klinikums Stuttgart
  • C. Musahl - Neurochirurgische Klinik des Klinikums Stuttgart

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 041

DOI: 10.3205/11dgnc262, URN: urn:nbn:de:0183-11dgnc2626

Published: April 28, 2011

© 2011 Füllbier et al.
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Outline

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Objective: Spinal aneurysms are extremly rare. Only a handful of cases have been described in the literature. We present a case of a 51-year-old woman presenting with sudden onset of back pain and progressive neurologic deficit due to massive spontaneous spinal subarachnoid hemorrhage of a thoracic intradural aneurysm.

Methods: The patient presented to our hospital after the sudden onset of back pain accompanied by headache, nausea and vomiting. Bladder function was disturbed and an ascending sensory loss was described, originating in the perianal region. Spinal MRI showed a thoracic intradural hemorrhage ranging from vertebra T4 to T8. Spinal angiography showed an intradural aneurysm dorsal to the spinal cord and slightly left of the midline projecting to vertebra T5.

Results: Surgical treatment was performed for the decompression of the spinal cord as well as resection of the aneurysm. A left-sided hemilaminectomy at T5 was chosen as the approach. After opening of the dura, a thick membrane of coagulated blood was resected before the aneurysm was identified. Test occlusion of the parent vessel did not lead to any changes of evoked sensory or motor potentials. Therefore, the aneurysm was trapped and resected to eliminate the danger of rebleeding. After surgery the patient made a full recovery including bladder function.

Conclusions: Even though spinal aneurysms are extremely rare, they represent a pathology that must be kept in mind, especially when one encounters a spinal intradural hemorrhage. In most cases, diagnosis can only be made by spinal angiography, which is time-consuming and not available in every center. Surgical resection in most cases is not complicated since most spinal aneurysms arise from dorsal arteries. To prevent neurologic worsening of the patient, intraoperative neurophysiologic monitoring is essential.