Ruptured Isolated aneurysm of a coronal branch of the anterior spinal artery. Case report and discussion of treatment strategies.

Abstract BACKGROUND Isolated spinal artery aneurysms are an extremely rare cause of subarachnoid hemorrhage. A limited number of case reports and case series have been reported in the literature, and for the uncertain natural history of these lesions, there is no univocal consensus about the optimal treatment between conservative management, surgical clipping/trapping or endovascular treatment. CASE PRESENTATION We report a case of a 64-year-old man presented with subarachnoid hemorrhage from a ruptured anterior spinal artery aneurysm at the C1 level. Despite the initial conservative management, surgical treatment was proposed due to an increase in lesion size at angiographic follow-up. Thus, a partially thrombosed aneurysm was found during surgery, suggesting that a spontaneous resolution of the aneurysm was occurring. Despite the initial worsening of neurological symptoms, the patient gradually recovered after rehabilitation. CONCLUSIONS Treatment decisions for spinal aneurysms should be defined case by case, trying to offer the patient the best option, avoiding exposure to unnecessary invasive procedures. As the spontaneous resolution of a spinal artery aneurysm is unpredictable, our case highlights the importance of performing a perioperative vascular study if surgery is planned.