Research Fellow, PhD Candidate Mayo Clinic Rochester Rochester, Minnesota, United States
Introduction: Extracranial vertebral artery aneurysms are rare complications resulting from trauma and multiple different diseases. However, the difference between clinical and surgical profiles is not well understood. Our study aims to investigate the clinical and interventional outcomes following extracranial vertebral artery aneurysms(VAA) treatment through a systematic review of the literature to date.
Methods: An electronic database search for full-text English articles was conducted following PRISMA guidelines. The search yielded results on clinical and surgical outcomes for extracranial VAA. These results included patient-specific risk factors, indications, and techniques.
Results: Our literature search resulted in 561 articles, of which 36 studies were qualified to be included in the analysis. A total of 55 patients with multiple various extracranial VAA incidents were included. The mean age of subjects was 42 years (13 to 76 years), and the majority of patients were males (71%,n =39). Blunt trauma was the most frequent risk factor for extracranial VAA formation (35%,n =19). The majority of aneurysms (60%) were dissecting in nature. The most common form of treatment for extracranial VAAs was the use of a flow diverter (24%,n=13). Overall, five (9%) patients had long term adverse neurological complications following intervention with 5% (n=3) mortality, 2% (n=1) resulting in unilateral vocal cord paralysis, and 2% (n=1) resulted in a positive Romberg sign. The mortality rate is 15.7% in the surgical group, whereas the endovascular treatment did not result in any mortality.
Conclusion : The endovascular approach is a safe and effective treatment of extracranial VAAs due to its relatively low overall complication rate and lack of resulting mortality. This is in contrast to the surgical approach which results in a higher rate of complications, recurrence, and mortality outcomes. An understanding of the factors and clinical outcomes associated with the incidence of extracranial VAA is essential for the future improvement of patient outcomes.
