gms | German Medical Science

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.