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

• Published in: Neuro-chirurgie Vol. 64; no. 3; pp. 177 - 182
• Main Authors: Todeschi, J., Chibbaro, S., Gubian, A., Pop, R., Proust, F., Cebula, H.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-06-2018
• Subjects: Adhesive arachnoiditis; Arachnoid cyst; Arterial dissection; Spinal aneurysm; Spinal subarachnoid haemorrhage; Arachnoid cyst; Arterial dissection; Adhesive arachnoiditis; Spinal aneurysm; Spinal subarachnoid haemorrhage
• ISSN: 0028-3770; 1773-0619
• DOI: 10.1016/j.neuchi.2017.11.003

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.
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.
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.
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.