Surgical clipping of flow related giant unruptured anterior spinal artery aneurysm secondary to co-arctation of aorta: Management challenges and lessons learnt

Abstract

Background: Anterior spinal artery aneurysms (ASAA) are extremely rare. While these aneurysms are very well known to cause spinal subarachnoid haemorrhage/hematomyelia secondary to sudden rupture, presentation with chronic myelopathy remains extremely rare. Case report: A 50-year-old gentleman presented with chronic upper thoracic myelopathy for 1 year. MRI of the dorsal spine revealed an intradural T2 hypointense mass with prominent vessels at T1 level. During intra-arterial angiography, accidental diagnosis of a co-existent co-arctation of the aorta was made. The intradural spinal mass turned out to be a giant, partially thrombosed ASA aneurysm on angiography. This patient underwent surgical clipping of the aneurysm utilizing a posterolateral approach. The patient experienced a stormy early postoperative period due to acute renal failure and pulmonary edema that settled down by the time of discharge. Conclusion: ASAA remains an extremely rare cause of compressive myelopathy. Its association with co-arctation of aorta increases treatment related mortality. Posterolateral approach provides a good exposure of the aneurysm for surgical clipping with minimal retraction of the cord. Keywords: Unruptured, Clipping, Thoracic spine, Spinal artery, Co-arctation