Isolated spinal artery aneurysm treatment: a systematic review of the literature and an illustrative case of the neuromonitoring-assisted resection.

IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY
Journal of neurosurgical sciences Pub Date : 2025-10-01 Epub Date: 2025-08-01 DOI:10.23736/S0390-5616.25.06529-4
Fabio Serpico, Antonio Meola, Federico Saturno Spurio, Corrado Iaccarino, Giacomo Pavesi, Leonello Tacconi
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引用次数: 0

Abstract

Introduction: Isolated spinal artery aneurysms (ISAAs) are rare, often presenting with sub-arachnoid hemorrhage (SAH) and severe neurological deficits. Conclusive evidence about the best management approach is lacking.

Evidence acquisition: Following PRISMA guidelines, a systematic review of papers about ISAAs management was conducted from 1966 to 2024, evaluating age, sex, risk factors/comorbidities, aneurysm rupture and location, treatment modalities and clinical outcome. An illustrative case of a 65-year-old woman with a an ISAA of a radiculomedullary artery at T8 level was reported.

Evidence synthesis: Overall, 106 studies obtained from the literature review showed 138 patients received an ISAA diagnosis and were managed with surgery (52.1%), observation (31.1%), or endovascular treatment (11.5%), with clinical improvement in 76.4%, 86%, 81.2% of cases, respectively. The treatment option was not reported in 5.3% of cases. Only two patients presented neurological worsening related to vasospasm, and none had rebleeding after treatment. The mean follow-up was 8.7 months (range 0.03-73 months). In the reported illustrative case, after left T7-T8 laminectomy and dural opening, a little thrombosed aneurysm was found. Under doppler and neurophysiological monitoring, temporary clips were placed on the afferent and efferent vessel and the aneurysm was resected. The patient reported complete and stable regression of symptoms. No complications were detected after 6 months. Imaging showed complete resection of the aneurysm.

Conclusions: Surgical resection under neurophysiological monitoring is an excellent treatment option to both eliminate the risk of rebleeding, while preserving the neurological function. Observation and endovascular treatment may lead to comparable neurological outcomes. Larger multicentric studies with longer follow-up are needed to determine the best management option.

孤立性脊髓动脉瘤的治疗:对文献的系统回顾和神经监测辅助切除的一例说明性病例。
孤立性脊髓动脉瘤(ISAAs)是罕见的,通常表现为蛛网膜下腔出血(SAH)和严重的神经功能缺损。目前还缺乏关于最佳管理方法的确凿证据。证据获取:遵循PRISMA指南,对1966年至2024年有关ISAAs管理的论文进行了系统回顾,评估年龄、性别、危险因素/合并症、动脉瘤破裂和位置、治疗方式和临床结果。我们报道了一例65岁女性在T8水平发生根髓动脉ISAA的病例。证据综合:总体而言,从文献综述中获得的106项研究显示,138例患者接受了ISAA诊断,并进行了手术(52.1%)、观察(31.1%)或血管内治疗(11.5%),分别有76.4%、86%和81.2%的病例临床改善。5.3%的病例未报告治疗方案。仅有2例患者出现与血管痉挛相关的神经系统恶化,治疗后无再出血。平均随访8.7个月(0.03 ~ 73个月)。在报告的说明性病例中,在左侧T7-T8椎板切除术和硬脑膜打开后,发现了一个小的血栓性动脉瘤。在多普勒和神经生理监测下,在传入和传出血管上放置临时夹,切除动脉瘤。患者报告症状完全稳定消退。6个月后未发现并发症。影像学显示动脉瘤完全切除。结论:在神经生理监测下手术切除是一种良好的治疗选择,既可以消除再出血的风险,又可以保留神经功能。观察和血管内治疗可能导致类似的神经学结果。需要更大的多中心研究和更长的随访时间来确定最佳的治疗方案。
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来源期刊
Journal of neurosurgical sciences
Journal of neurosurgical sciences CLINICAL NEUROLOGY-SURGERY
CiteScore
3.00
自引率
5.30%
发文量
202
审稿时长
>12 weeks
期刊介绍: The Journal of Neurosurgical Sciences publishes scientific papers on neurosurgery and related subjects (electroencephalography, neurophysiology, neurochemistry, neuropathology, stereotaxy, neuroanatomy, neuroradiology, etc.). Manuscripts may be submitted in the form of ditorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work.
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