Radiculomedullary artery malformations are rare conditions: their rupture usually manifests with subarachnoid hemorrhage. To the best of our knowledge no cases of subdural bleeding have been described in the literature. We present the rare case of a 74 year old woman admitted to our Institute with sudden onset of right lower limb motor deficit and hypoesthesia, with no history of trauma: Magnetic Resonance Imaging of the dorsal spine was performed and a subdural hematoma was detected; subsequent dorsal laminectomy for hematoma evacuation was carried out. As the source of bleeding was not recognized, Digital Subtraction Angiography (DSA) was performed: a new leak of contrast agent from a dilation of a spinal radicular artery at the level of T5 was detected; XperCT imaging (an angiographic acquisition of Computed Tomography-like images) confirmed a new acute subdural bleeding. Urgent repeat surgery was considered the best option to identify and close the malformation. Postoperative DSA confirmed complete exclusion of the radicular artery malformation. This is the first report that describes, with an intraoperative video, a case of radiculomedullary artery pseudoaneurysm, responsible of an acute subdural bleeding and associated neurological deficit.

中文翻译：

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胸神经根动脉假性动脉瘤破裂导致背侧硬膜下出血。病例报告和手术视频

神经根髓动脉畸形是罕见的情况：它们的破裂通常表现为蛛网膜下腔出血。据我们所知，文献中没有描述硬膜下出血的病例。我们介绍了一名罕见的病例，一名 74 岁的女性因突然出现右下肢运动障碍和感觉减退而入院，没有外伤史：对背侧脊柱进行磁共振成像，检测到硬膜下血肿；随后进行了背侧椎板切除术以清除血肿。由于无法识别出血源，因此进行了数字减影血管造影（DSA）：检测到 T5 水平的脊髓根动脉扩张处有新的造影剂泄漏；XperCT 成像（计算机断层扫描样图像的血管造影采集）证实了新的急性硬膜下出血。紧急重复手术被认为是识别和闭合畸形的最佳选择。术后DSA证实完全排除了根动脉畸形。这是第一份使用术中视频描述一例导致急性硬膜下出血和相关神经功能缺损的神经根髓动脉假性动脉瘤病例的报告。