Lateral sacral artery aneurysm of the lumbar spine: hemorrhage resulting in cauda equina syndrome
- Raul G Nogueira1,2,
- Ekkehard Kasper3,
- Brian P Walcott4,
- Brian V Nahed4,
- Navid Redjal4,
- Jean-Valery Coumans4,
- Joshua A Hirsch1
- 1Division of Interventional Neuroradiology and Endovascular Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- 2Division of Vascular and Critical Care Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- 3Department of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
- 4Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Correspondence to Dr J-V Coumans, Department of Neurosurgery, Massachusetts General Hospital, WACC 021, 15 Parkman Street, Boston MA 02114, USA;
- Received 29 December 2009
- Revised 23 March 2010
- Accepted 25 March 2010
- Published Online First 9 June 2010
Objective To describe the effective treatment of a ruptured lateral sacral artery aneurysm presenting as a spinal epidural hematoma.
Design Case report and literature review.
Setting University teaching hospital, neurovascular center.
Participant A man with a history of renal allograft who presented with sudden onset low back pain.
Intervention The patient underwent emergent decompressive surgery, diagnostic angiogram and endovascular embolization.
Main outcome measure Obliteration of aneurysm and restoration of neurological function.
Results Surgery resulted in decompression of the cauda equina. The patient's aneurysm was endovascularly obliterated. There was complete restoration of neurological function.
Conclusion Lateral sacral artery aneurysm formation and rupture is a rare cause of epidural hemorrhage and one described only in patients who have undergone renal transplantation. It may be caused by high flow from transpelvic collaterals between both internal iliac arteries. Treatment includes endovascular obliteration and may necessitate operative decompression in the setting of neurological compromise.
Competing interests None.
Patient consent Detail has been removed from this case description to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Provenance and peer review Not commissioned; externally peer reviewed.