Endoscopic Endonasal Transodontoid Treatment of a Ruptured Anterior Spinal Artery Aneurysm

Abstract

Isolated spinal artery aneurysms are a rare cause of intracranial subarachnoid hemorrhage (SAH). A 49-year-old female presented with severe headache. Initial imaging showed SAH and intraventricular hemorrhage (IVH), but no clear source of bleeding was identified. One week into being observed in the intensive care unit, she reported another severe headache. Computed tomography head showed more SAH and IVH. A second angiogram revealed a ruptured small anterior spinal artery (ASA) aneurysm at the craniocervical junction. She underwent a C1-2 fusion followed by an endoscopic endonasal transodontoid approach and wrapping of the ASA aneurysm. At 2 years' follow-up, there was no sign of aneurysm growth or rerupture. This is the first reported case of an endoscopic endonasal transodontoid approach to an aneurysm.

Keywords: anterior spinal artery aneurysm; endoscopic endonasal transodontoid.

Fig. 1

Computed tomography (CT) head demonstrating acute intraventricular hemorrhage involving the anterior horns of the lateral ventricles as well as the third and fourth ventricles. Almost all basal cisterns are effaced.

Fig. 2

Angiography demonstrates a 1.3-mm diameter aneurysm arising from the anterior spinal artery at the C1 level (black arrow). There is mild-moderate vasospasm of the posterior circulation related to the patient's prior subarachnoid hemorrhage. There is no other supply to the anterior spinal artery from the more proximal right vertebral artery or from the left vertebral artery.

Fig. 3

Postoperative T1 magnetic resonance imaging (MRI) showing postoperative corridor and fat graft.