This is a systematic review of clinical presentations, treatment approaches and outcomes on subarachnoid hemorrhage (SAH) from aneurysms of the artery of Adamkiewicz (AA).

The artery of Adamkiewicz (AA) is a critical vessel that supplies the anterior spinal artery to the lower spinal cord.  Aneurysms of the AA are understudied due to their rarity, but carry high clinical significance due to the risk of SAH and spinal cord infarction. 

We searched PubMed/Medline databases through 2025 for reports of aneurysmal SAH from AA, as well as added our own case experience.

18 patients with SAH from aneurysms of AA were found.  9 men and 9 women, mean age 44 +/- 18 years old were reported.  All presented with lower back pain, and spinal symptoms.  33% presented with headaches.  All were found to have spinal SAH. 44% had evidence of intracranial SAH.  The AA arose from T6 (5.5%), T9 (11%), T10 (11%), T11 (27.7%), T12 (27.7%), L1 (11%), L2 (5.5%).  All aneurysms were classified as fusiform, dissecting or pseudoaneurysms.  61.1% of patients were treated with conservative observation, 22.2% underwent surgery for wrapping or clipping, 11% had endovascular occlusion, and 5.5% treatment information not recorded.  Of the conservatively treated patients, 73% had complete aneurysm occlusion and recovery.  All surgical patients had complete recoveries with no mention of aneurysm occlusion.  For the patients undergoing endovascular therapies, one had a partial recovery, and the other patient had a complete recovery.  One patient died with no mention of treatment approach.  The mean follow up of this case series was 19 weeks +/- 55 weeks.

Surgical and endovascular treatment methods for patients with SAH from aneurysms of the AA were technically challenging and potentially risky, but demonstrated good outcomes. However, the majority of cases reported were treated conservatively with spontaneous aneurysm occlusion and similar excellent outcomes.