Vertebrobasilar Artery Aneurysms: An Uncommon Cause of Vertigo

Abstract

Objective: Review our experience with vertebrobasilar artery aneurysms and discuss factors which may enable clinicians to distinguish between these potentially life-threatening posterior circulation aneurysms and other conditions with similar presentations. Method: Case series with chart review. The charts of patients who underwent surgical management of posterior circulation aneurysms at a tertiary care center between December 1995 and February 2008 were reviewed. Results: A total of 57 patients (40 females, 17 males) with an average age of 52.8 years (range, 27-79 years) were included. A total of 44 patients were white, 5 were African American, and 8 were unspecified. Aneurysms of the posterior communicating artery and posterior inferior cerebellar artery were most common, occurring in 28 (49%) and 26 (46%) of patients, respectively. The most common initial symptoms were headache in 31 patients (54%) and acute mental status changes in 18 patients (32%). Eight patients (14%) presented acutely with dizziness or vertigo. 26 patients (46%) underwent suboccipital craniotomy with aneurysm clipping. Fifteen (26%) underwent frontotemporal craniotomy, and 5 (9%) underwent a combined neurosurgical-neurotologic approach. There were 8 deaths. Conclusion: Vertebrobasilar aneurysms are uncommon and typically present emergently after rupture. A small number of patients with such aneurysms may present with neurotologic symptoms, such as vertigo and disequilibrium. Given the potentially grave consequences of a ruptured aneurysm, it is essential that otolaryngologists remain cognizant of the presentation of posterior circulation aneurysms.