Intercostal aneurysm causing spinal cord compression in an NF1 patient

Purpose: The authors illustrate a case where an intercostal aneurysm was observed in a patient with type 1 neurofibromatosis. Methods: A 32-year-old man with NF1 presented with thoracic back pain. The patient’s symptoms progressed to include myelopathic symptoms, including difficulty urinating, numbness in the lower extremities, and increased weakness. Imaging revealed what appeared to be a neurofibroma at the T4–T5 level and a plan to resect the mass was formulated. Upon initial limited hemilaminotomy, significant arterial blood was encountered. The patient was then taken to the interventional suite and angiography was performed, revealing a left T4 intercostal aneurysm. The aneurysm was coil-embolized with no residual filling. Results: By 6 months post-surgery, the patient had regained full strength and sensation in his lower extremities and no longer had difficulty urinating. There has been no recurrence of symptoms 3 years postoperatively. Conclusions: Intercostal artery lesions must be considered as a possible diagnosis in NF1.[Figure not available: see fulltext.]