gms | German Medical Science

Objective: Spinal pseudoaneurysm are a rare but possible complications after spinal surgical interventions. Some case reports describe these types of iatrogenic injuries, most of them involving lumbar interbody fusion techniques or vertebral biopsies. In this case study we present a German female patient with a subarachnoid hemorrhage and following hydrocephalus malresorptivus. An external ventricular drain was initially placed and later replaced by a lumbar drain, which caused a pseudoaneurysm by injuring a segmental artery. There are no statistics showing the frequency of this kind of complication and its management.

Methods: A selected Pubmed research was performed using the key words: “iatrogenic spinal aneurysm”, “iatrogenic spinal hematoma”, “spinal aneurysm” and “lumbar puncture complication”. The data were evaluated with regard to the frequency of complications and what kind of surgical intervention was performed.

Results: We report the case of a 72-year-old German woman presented at our department with acute headache and meningism, without any neurological deficit. Computed tomography (CT) imaging showed a subarachnoid hemorrhage. Because of a known atrial fibrillation she was under oral anticoagulation with Rivaroxaban. Due to a beginning hydrocephalus malresorptivus a ventricular drain was placed without any complications. Digital subtraction angiography (DSA) confirmed a left vertebral incidental fusiform aneurysm, with no therapy relevance. A lumbar drain replaced the ventricle drain after two weeks. The placement was difficult because of advanced lumbar osteochondrosis; at the end it drained spinal fluid without any problems. After two days the patient showed signs of acute anemia. Hemolysis parameters were determined, with normal levels of lactic dehydrogenase, reticulocytes, bilirubin and haptoglobin. Abdominal-CT showed a right retroperitoneal localized hematoma spreading down through the psoas muscle caused by a pseudoaneurysm of the second right lumbar artery. 48 hours later the abdominal-CT revealed the bleeding still being active and an increase of the retroperitoneal hematoma volume. Digital spinal angiography was performed in general anesthesia. A complete embolization was achieved via coiling without any complications.

Conclusion: To our knowledge this is the first published case of lumbar puncture induced pseudoaneurysm. Common and well-known complications after lumbar punctures are: post puncture headache, bleeding, infection, radicular pain or numbness and more uncommon: cerebral herniation. There are a few published cases reporting about vascular injuries after spinal surgery, which were successfully endovascularly embolized. It is important to acknowledge possibility of this complication.