Minimally Invasive Approach for the Removal of a Ruptured Radiculomedullary Artery Aneurysm: Case Report and Literature Review.
Aneurysm, Ruptured
/ complications
Back Pain
/ etiology
Decompression, Surgical
Diagnosis, Differential
Diagnostic Errors
Female
Hematoma, Epidural, Spinal
/ diagnosis
Humans
Intracranial Aneurysm
/ complications
Ligation
Magnetic Resonance Imaging
Middle Aged
Minimally Invasive Surgical Procedures
Neuroimaging
Subarachnoid Hemorrhage
/ etiology
Suction
Vascular Surgical Procedures
Minimally invasive surgery
Neuromonitoring
Radiculomedullary artery aneurysm
Spinal subarachnoid hemorrhage
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
10
03
2019
accepted:
21
03
2019
pubmed:
2
4
2019
medline:
21
1
2020
entrez:
2
4
2019
Statut:
ppublish
Résumé
Radiculomedullary arteries aneurysms are rare, with only few cases so far reported. We report the case of a 54-year-old woman with sudden onset of upper thoracic back pain. Magnetic resonance imaging/magnetic resonance angiography of the spine showed a cervico-thoraco-lumbar hematoma, with no evidence of underlying vascular malformations. Using Phantom retractors, a unilateral laminectomy was performed at the level of T3, in proximity of the thickest part of the epidural hematoma. No epidural blood was detected. The dura was opened, and subdural and subarachnoid blood was found. After its removal, a fusiform aneurysm of the right radiculomedullary artery was found. The parental vessel was temporarily clipped and the aneurysm removed after ligation of both proximal and distal vessels. No postoperative complications occurred. Rupture of radiculomedullary artery aneurysm always should be considered as differential diagnosis in patients with sudden onset of isolated back pain, headache, and spinal epidural/subdural bleeding. Among different possible treatments, surgery represents a valid option. The use of microsurgical techniques is crucial to achieve a good clinical outcome. A minimally invasive approach can be used to minimize muscle disruption, with minimal blood loss, and faster recovery.
Sections du résumé
BACKGROUND
BACKGROUND
Radiculomedullary arteries aneurysms are rare, with only few cases so far reported.
CASE DESCRIPTION
METHODS
We report the case of a 54-year-old woman with sudden onset of upper thoracic back pain. Magnetic resonance imaging/magnetic resonance angiography of the spine showed a cervico-thoraco-lumbar hematoma, with no evidence of underlying vascular malformations. Using Phantom retractors, a unilateral laminectomy was performed at the level of T3, in proximity of the thickest part of the epidural hematoma. No epidural blood was detected. The dura was opened, and subdural and subarachnoid blood was found. After its removal, a fusiform aneurysm of the right radiculomedullary artery was found. The parental vessel was temporarily clipped and the aneurysm removed after ligation of both proximal and distal vessels. No postoperative complications occurred.
CONCLUSIONS
CONCLUSIONS
Rupture of radiculomedullary artery aneurysm always should be considered as differential diagnosis in patients with sudden onset of isolated back pain, headache, and spinal epidural/subdural bleeding. Among different possible treatments, surgery represents a valid option. The use of microsurgical techniques is crucial to achieve a good clinical outcome. A minimally invasive approach can be used to minimize muscle disruption, with minimal blood loss, and faster recovery.
Identifiants
pubmed: 30930328
pii: S1878-8750(19)30905-2
doi: 10.1016/j.wneu.2019.03.225
pii:
doi:
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
605-610Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.