Elsevier

Neurochirurgie

Volume 64, Issue 3, June 2018, Pages 177-182
Neurochirurgie

Update
Spinal adhesive arachnoiditis following the rupture of an Adamkiewicz aneurysm: Literature review and a case illustration

https://doi.org/10.1016/j.neuchi.2017.11.003Get rights and content

Abstract

Background

The rupture of an isolated spinal aneurysm is an exceptional occurrence. It might be responsible for a spinal subarachnoid haemorrhage (SSAH) that in rare cases can be complicated by arachnoiditis. Among the former the adhesive type is the most severe leading to the formation of a cyst and/or a syrinx.

Patients and methods

The literature review was performed via a PubMed search using the following keywords.

Adhesive arachnoiditis; spinal subarachnoid haemorrhage; spinal arachnoiditis; spinal arachnoid cyst; arachnoid cyst .Thesearch yielded 24 articles. Given the fact that only a few studies had been reported on the subject, we decided to include all studies regarding adhesive arachnoiditis after SAH leading to a descriptive literature review. Furthermore, a case illustration of a 57 year old man harbouring this type of rare pathology is described.

Results

Twenty-four case reports were found regarding spinal adhesive arachnoiditis (SAA) following SSAH. Posterior cerebral circulation bleeding (66.7%) most often occurred followed by spinal (9.1%) and anterior cerebral circulation (9.1%) respectively. The mean time between the haemorrhage and the SAA onset was 10 months. A higher predominance of symptomatic thoracic SAA was found. Including the present case, 80% of patients had a laminectomy, 72% had a micro adhesiolysis, and 56% a shunt placement. Cervical and upper thoracic involvement appeared to have a better outcome.

Conclusion

Although most authors suggested surgical treatment, the long-term outcome remains unclear. Early stage diagnosis and management of this rare and disabling pathology may lead to a better outcome. Larger co-operative studies remain essential to obtain a better understanding of such a rare and complex disease.

Section snippets

Abbreviations

    SAA

    spinal adhesive arachnoiditis

    SAH

    subarachnoid haemorrhage

    SSAH

    spinal subarachnoid haemorrhage

    AVM

    arteriovenous malformation

    CSF

    cerebrospinal fluid

    CT scan

    computerized tomography scan

    MRI

    magnetic Resonance Imaging

    RCT

    randomized controlled trials

    DSA

    Digital Subtraction Angiography

Patients and methods

The literature review was performed via a PubMed search using the following keywords.

Adhesive arachnoiditis, Spinal subarachnoid haemorrhage, Spinal arachnoiditis, spinal arachnoid cyst, arachnoid cyst, the search yielded a total of 24 articles.

Due to the presence of only a few reported studies on this subject, we decided to include all studies reporting cases of adhesive arachnoiditis after a subarachnoid haemorrhage leading to a descriptive literature review. Descriptive statistics of the

Population

Twenty-four case reports [1], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34] were found regarding SAA following a SSAH. Thirty-four patients, including the present case, were described, 23 were women and 7 were men (in 2 studies, in 4 patients, the age and sex of the patients, was not stated). The mean age was 57 years (range 22–73 years) all the results are summarised on Table 1.

Although location of the

Case illustration

A 57 year-old man with no significant past medical history presented at a peripheral hospital with sudden and severe epigastric pain associated with back pain and signs of meningeal irritation. A few hours later the patient developed diffuse lower limb paraesthesia. An urgent head CT-scan revealed a peri-mesencephalic SAH.

A subsequent cerebral DSA was normal. The patient underwent further examinations and a spine MRI showed a round intra-dural lesion anterior to the spinal cord at the level of

Overview

First reported in 1943 [36] SAA is an extremely rare complication of SAH which can occur months to years after the causative event [1], [14], [30]. Other causes of inflammation of the pial-arachnoid membrane include: meningitis [37], spinal trauma and intra-thecal injections [3], [4].

Morphological and clinical aspects

Regarding the most frequent thoracic localisation of SAA, we can speculate that the former is related to the intrinsic anatomical configuration of this region being the size of the canal relatively smaller than the

Conclusion

Spinal adhesive arachnoiditis is rare and a recognised consequence of SAH. It can occur under many conditions, surprisingly, even in cerebral anterior circulation aneurysm bleeding. It appears to be associated with a better outcome if located in the cervical levels. Early identification seems to have a positive impact on outcome and treatment by laminectomy, microadhesiolysis and eventually shunting as the most often reported strategy and seems to be associated with neurological improvement or

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

Role of funding and source

No funding was received for this research.

Disclosure of interest

The authors declare that they have no competing interest.

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