Spinal aneurysm

Spinal aneurysms (SAs) are a very rare pathology to be encountered as compared to intracranial aneurysms. The first ever described spinal aneurysm was in 1930. Djindjian and his colleagues found that the incidence rate is less than 1 in every 3000 cases who had a spinal angiogram. Given its rarity, there is no unified system to classify spinal aneurysms. Nearly 55% of all presented SAs were isolated once. Unlike intracranial aneurysms, spinal aneurysms are usually lacking a surgical neck. Histopathology was described as dissecting aneurysms, and the incidence of a fusiform aneurysm in the spine was found to be more common. However, saccular aneurysms were also reported. Most cases present with ruptured spinal aneurysms, usually smaller than intracranially (<3 mm in diameter) and located at the cervical level. Also, the mean diameter of aneurysms was 9 mm (range 3-27 mm). The clinical presentation usually varies, but the sudden onset of low back pain is the most common. Presenting with or without hemorrhage in the subarachnoid space was irrelevant to its size or predictive of the outcome or mortality as in those with cranial origin. An earlier review in 1957 by Henson and Crof described cervical aneurysms as unlikely to present in a living patient. The management of spinal aneurysms includes conservative or surgical or endovascular options. The choice of treatment pathway should be individualized according to the case as it varies with the location of the aneurysm, rupture status, related angiographic findings, clinical status of the patient, and time frame from presentation in cases with a significant deficit. We will explore the treatment principles with case examples in this chapter.