title: Intracranial Vertebral Artery Aneurysms: Clinical Features and Outcome of 190 Patients.
abstract: BACKGROUND
  Vertebral artery (VA) aneurysms comprise approximately one-third of posterior circulation aneurysms. They are morphologically variable, and located critically close to the cranial nerves and the brainstem. We aim to represent the characteristics of these aneurysms and their treatment, and to analyze the outcome.
  
  
  METHODS
  We reviewed retrospectively 9709 patients with intracranial aneurysms. Of these, we included 190 with aneurysms at the VA or VA-posterior inferior cerebellar artery junction. These patients were treated in the Department of Neurosurgery, Helsinki, Finland, between 1934 and 2011.
  
  
  RESULTS
  The 190 patients had 193 VA aneurysms, among which 131 (68%) were ruptured. The VA aneurysm caused a mass effect in 7 and ischemia in 2 patients. Compared to 4387 patients with a ruptured aneurysm in other locations, those with a VA aneurysm were older, their aneurysms were more often fusiform, and more often caused intraventricular hemorrhages. Among surgically treated aneurysms, clipping was the treatment in 91 (88%) saccular and 11 (50%) fusiform aneurysms. Treatment was endovascular in 13 (9%), and multimodal in 6 (4%) aneurysms. Within a year after aneurysm diagnosis, 53 (28%) patients died. Among the survivors, 104 (93%) returned to an independent or to their previous state of life; only 2 (2%) were unable to return home.
  
  
  CONCLUSIONS
  Microsurgery is a feasible treatment for VA aneurysms, although cranial nerve deficits are more common than in endovascular surgery. Despite the challenge of an often severe hemorrhage, of challenging morphology, and risk for laryngeal palsy, most patients surviving the initial stage return to normalcy.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: hanna.lehto@hus.fi.
authors.forename: Hanna
authors.initials: H
authors.lastname: Lehto
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Riku
authors.initials: R
authors.lastname: Kivisaari
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Aki
authors.initials: A
authors.lastname: Laakso
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Behnam Rezai
authors.initials: BR
authors.lastname: Jahromi
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Ferzat
authors.initials: F
authors.lastname: Hijazy
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Hugo
authors.initials: H
authors.lastname: Andrade-Barazarte
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Reza
authors.initials: R
authors.lastname: Dashti
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D005387:Finland; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014711:Vertebral Artery; D055815:Young Adult
keywords: Cerebral aneurysm; Microneurosurgery; Vertebral artery