Management of intercostal artery pseudoaneurysm following posterior pedicle screw insertion: illustrative case.

Journal of neurosurgery. Case lessons Pub Date : 2025-01-27 DOI:10.3171/CASE24291

Mohammad Ghorbani, Mohammadtaghi Imanikhosroshahi, Reza Mollahoseini, Homayoon Khaledian

{"title":"Management of intercostal artery pseudoaneurysm following posterior pedicle screw insertion: illustrative case.","authors":"Mohammad Ghorbani, Mohammadtaghi Imanikhosroshahi, Reza Mollahoseini, Homayoon Khaledian","doi":"10.3171/CASE24291","DOIUrl":null,"url":null,"abstract":"Background: Pedicle screw insertion in posterior spinal surgery can cause vascular injuries, including rare intercostal artery pseudoaneurysms, which are typically discovered incidentally during reimaging. Onyx embolization is an effective treatment for small artery pseudoaneurysms.Observations: A 36-year-old man who had initially presented with back pain that remained unresponsive to nonsteroidal anti-inflammatory drugs was diagnosed with a T7-8 sarcomatous lesion confirmed by magnetic resonance imaging and biopsy. He underwent a posterior resection and T5-10 stabilization with pedicle screws. After surgery, significant hemorrhage led to his transfer for digital subtraction angiography, which revealed a prominent vascular tumor blush and a pseudoaneurysm of the right T5 intercostal artery due to screw placement. The tumor and pseudoaneurysm were effectively embolized using superselective catheterization and Onyx.Lessons: This report highlights the dangers of intercostal artery damage from posterior spinal screws, emphasizing the need for meticulous postoperative imaging. Onyx embolization is an effective treatment for such complications. https://thejns.org/doi/10.3171/CASE24291.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 4","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775989/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurosurgery. Case lessons","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3171/CASE24291","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Pedicle screw insertion in posterior spinal surgery can cause vascular injuries, including rare intercostal artery pseudoaneurysms, which are typically discovered incidentally during reimaging. Onyx embolization is an effective treatment for small artery pseudoaneurysms.

Observations: A 36-year-old man who had initially presented with back pain that remained unresponsive to nonsteroidal anti-inflammatory drugs was diagnosed with a T7-8 sarcomatous lesion confirmed by magnetic resonance imaging and biopsy. He underwent a posterior resection and T5-10 stabilization with pedicle screws. After surgery, significant hemorrhage led to his transfer for digital subtraction angiography, which revealed a prominent vascular tumor blush and a pseudoaneurysm of the right T5 intercostal artery due to screw placement. The tumor and pseudoaneurysm were effectively embolized using superselective catheterization and Onyx.

Lessons: This report highlights the dangers of intercostal artery damage from posterior spinal screws, emphasizing the need for meticulous postoperative imaging. Onyx embolization is an effective treatment for such complications. https://thejns.org/doi/10.3171/CASE24291.

查看原文