Vertebral Artery Aneurysm

Epidemiology

Aneurysms of the extracranial vertebral artery are rare. They usually result from penetrating gunshot or stab wounds. Cervical spinal surgery, birth trauma, cervical fractures, and dislocations have also been implicated. These commonly occur in the terminal cervical portion from the C2 level to the skull base or where the artery curves to enter the foramen transversarium of the sixth cervical vertebra. Atraumatic aneurysms are even less frequent. They may be secondary to the vasculopathy as in Ehlers-Danlos syndrome, neurofibromatosis, and fibromuscular dysplasia. Degenerative aneurysms due to atherosclerotic disease usually occur in older age groups with no gender predilection.

Clinical Features

Small aneurysms may be asymptomatic. Very large aneurysms may present as pulsatile neck masses. When dissection occurs, the patient has severe neck pain and associated vertigo and dizziness. Dissections may also result in a cerebellar infarct.

Pathology