Spontaneous Cervical Intramedullary and Subarachnoid Hemorrhage due to a Sulco-Commissural Artery Aneurysm

Abstract

Aneurysms of the arteries of the spinal cord are rare. They are known to be a potential cause of hematomyelia and subarachnoid hemorrhage. Most aneurysms are associated with and secondary to another vascular lesion with an arteriovenous shunt, e.g. spinal cord arteriovenous malformation (AVM). Within this group, aneurysms of the sulco-commissural arteries are infrequently reported. Due to their location within the spinal cord, endovascular treatment is generally favored over microsurgical extirpation. This article reports the case of an otherwise healthy woman with a spontaneous hemorrhage into the spinal cord and the subarachnoid space. Digital subtraction angiography (DSA) showed an aneurysm of a cervical sulco-commissural artery as the source of this hemorrhage as well as revealing a cervical intradural arteriovenous fistula. An unsuccessful attempt was made to catheterize the aneurysm, so it was decided to perform a microsurgical extirpation of the sulco-commissural aneurysm instead. Surgical access to the aneurysm was facilitated by the previous hemorrhage; however, it would most likely also be possible for an unruptured aneurysm of