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Case Reports
. 2014 Jan 14:5:2.
doi: 10.4103/2152-7806.124977. eCollection 2014.

Ruptured venous aneurysm of cervicomedullary junction

Ashish Aggarwal  1 , Pravin Salunke  1 , Sameer Futane  1 , S N Mathuriya  1 , Ajay Kumar  2 , K K Mukherjee  1 , B D Radotra  3
Affiliations
Case Reports

Ruptured venous aneurysm of cervicomedullary junction

Ashish Aggarwal et al. Surg Neurol Int. .

Abstract

Background: Ruptured venous aneurysm is often seen with arterio-venous malformation (AVM) or developmental venous anomaly (DVA). However, isolated venous aneurysm is unusual.

Case description: We present a case of ruptured venous aneurysm that presented with subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH). Digital substraction angiography (DSA) revealed a saccular contrast filling pouch in the left lateral aspect of cervicomedullary junction (CMJ). Endovascular intervention was not a viable option. During surgery, a saccular pliable structure approx. 1.5 × 1 cm was found in the subarachnoid space that was clipped and excised. There were no arterial feeders, no evidence of surrounding AVM, and no dilated perimedullary vein.

Conclusion: This is perhaps the first reported case of ruptured venous aneurysm (without associated AVM) of CMJ, which was successfully managed surgically. The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality. Surgically clipping and excision remains the treatment of choice for such lesion.

Keywords: Arterio-venous malformation; cervico medullary junction; venous aneurysm.

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Figures

Figure 1
Figure 1
(a) NCCT Head showing SAH and IVH, (b) 3D CT angiography seen from anterior aspect and above showing dilated vascular structure (shown by arrow) near posterior CVJ, (c and d) CT angiography coronal and sagittal reconstruction, showing dilated vascular structure (shown by arrow) near CVJ, (e) DSA in arterial phase does not show any aneurysm, (f) DSA in early venous and late arterial phase showing venous aneurysmal dialatation (arrow), (g and h) postoperative DSA showing nonfilling of aneurysm both in the arterial phase and (g) venous phase, (h) Aneurysm clip is seen
Figure 2
Figure 2
Intraoperative images showing: (a) a large pliable vascular lesion (marked with star), (b) dissection being done to identify the neck, (c) the feeding vein (dialated) being skeletonized and (d) aneurysm clip applied at the feeding vein. Aneurysm partially (hidden from view) marked with a star
Figure 3
Figure 3
(a) Cut section of thin walled Aneurysm with partial thrombus. No arterial ostia was found, (b) Wall of the aneurysm (×10) in elastic van geison stain does not show elastic fibers and (c) Wall of the aneurysm (×10) in H and E stain showing absence of elastic fiber layer
See this image and copyright information in PMC

References

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    1. Tyson GW, Jane JA, Strachan WE. Intracerebral hemorrhage due to ruptured venous aneurysm. Report of two cases. J Neurosurg. 1978;49:739–43. - PubMed

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