title: Non-saccular vertebrobasilar aneurysms and dolichoectasia: a systematic literature review.
abstract: OBJECTIVE
  Treatment of non-saccular vertebrobasilar aneurysms remains highly challenging despite significant recent advances in endovascular techniques. Establishing the natural history of this heterogeneous disease, as best as currently available data allows, is crucial to help guide counseling and management.
  
  
  METHODS
  A review of the literature was conducted to identify publications describing the presentation and natural history of vertebrobasilar dolichoectasia and non-saccular aneurysms.
  
  
  RESULTS
  Nine studies of 440 patients met the analysis inclusion criteria. The majority of patients presented with ischemia, mass effect, or incidentally; hemorrhage was uncommon and overlapped with the population of vertebrobasilar dissection. Overall mortality was ~40% after 7 years of follow-up, with 43% of these deaths resulting from non-neurologic causes. Neurologic course was dominated by ischemic stroke rather than hemorrhage. Mass effect prognosis was especially poor, with 40% mortality after ~4 years. Incidentally discovered lesions which remain morphologically stable have a favorable long term course.
  
  
  CONCLUSIONS
  Initial clinical presentation is a strong predictor of subsequent disease course. Although overall prognosis is poor, nearly half of all deaths resulted from non-neurologic causes, underscoring the importance of comprehensive medical management. Aneurysms characterized by expansion, established mass effect, or hemorrhage have a poor natural history, and may be considered for invasive treatment, which is increasingly endovascular in nature. Lesions presenting with ischemia or incidentally are likely best addressed with aggressive neurologic and overall medical management.
authors.affiliation: Bernard and Irene Schwartz Neurointerventional Radiology Section, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Maksim
authors.initials: M
authors.lastname: Shapiro
authors.forename: Tibor
authors.initials: T
authors.lastname: Becske
authors.forename: Howard A
authors.initials: HA
authors.lastname: Riina
authors.forename: Eytan
authors.initials: E
authors.lastname: Raz
authors.forename: Daniel
authors.initials: D
authors.lastname: Zumofen
authors.forename: Peter K
authors.initials: PK
authors.lastname: Nelson
mesh_terms: D002560:Cerebrovascular Circulation; D057510:Endovascular Procedures; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D014715:Vertebrobasilar Insufficiency / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*
keywords: Aneurysm; Artery; Hemorrhage; Posterior fossa; Stroke