{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:36:19Z","timestamp":1789605379996,"version":"build-2803163510"},"reference-count":78,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n High rates of retreatment remain a concern after endovascular therapy (EVT) for posterior circulation aneurysms. The authors aimed to analyze the indications and outcomes of microsurgery for posterior circulation aneurysms in the endovascular era.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A single institutional prospectively maintained database was queried from 2015 to 2025.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Sixty-seven aneurysms were treated with microsurgery. Females comprised 55.2% (n = 37) of the cohort, and the median age was 55.4 years. Aneurysms were located along the posterior inferior cerebellar artery (PICA) in 23 patients, distal intracranial vertebral artery (VA) in 13, basilar apex in 12, posterior cerebral artery (PCA) in 11, and superior cerebellar artery (SCA) in 8. Twenty-five patients (37.3%) presented with acute rupture\/subarachnoid hemorrhage (SAH). The median Hunt and Hess grade for patients who experienced SAH was II. The sizes of the aneurysms were < 4 mm in 8 patients, 4\u201310 mm in 34, 10\u201324 mm in 20, and > 24 mm in 5. Indications for microsurgery were complex anatomy in 22 patients, large thrombosed aneurysm not amenable to EVT in 13, residual aneurysm after prior EVT in 10, giant aneurysm in 9, distally located aneurysm in 10, partially thrombosed aneurysm in 3, residual aneurysm after prior clipping at an outside hospital in 6, mass effect in 2, and associated hematoma in 1. Microsurgical clip reconstruction was performed in 51 patients (76.1%), trapping with bypass in 5 (7.5%), parent vessel sacrifice in 3 (4.5%), trapping alone in 7 (10.4%), and wrapping in 1 (1.5%). Postoperative digital subtraction angiography (n = 61) confirmed complete occlusion in 54 patients (88.1%). Only 3.0% of patients (n = 2) needed retreatment for an enlarging residual among partially occluded aneurysms (n = 8, 11.9%). Complete occlusion was observed in 100% of SCA aneurysms (n = 8), 84.6% of VA aneurysms (n = 11\/13), 90.9% of PCA aneurysms (n = 10\/11), 85.7% of PICA aneurysms (18\/23), and 75% of BA aneurysms (n = 7). The median follow-up was 27.8 months, and 60 patients (90%) were alive, of whom 55 (93.2%) had a modified Rankin Scale (mRS) score of 0 or 1. SAH-related mortality was seen in 5 patients (20%). Advanced age (p = 0.018) and prior treatment (p = 0.004) predicted poor clinical outcome (mRS score > 3 or mortality) in multivariate logistic regression analysis.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Microsurgical techniques yielded excellent complete occlusion rates with low morbidity. Only 3% of patients with posterior circulation aneurysms needed additional treatment for aneurysms that were not amenable to or cured with EVT.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.9.focus25762","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:25:14Z","timestamp":1764595514000},"page":"E16","source":"Crossref","is-referenced-by-count":3,"title":["Are microsurgical techniques still indicated for posterior circulation aneurysms? A 10-year longitudinal analysis of clinical and radiological outcomes in the post-endovascular era"],"prefix":"10.3171","volume":"59","author":[{"given":"Sanjeev A.","family":"Sreenivasan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Stuart","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchit P.","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary K.","family":"Steinberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"J Neurosurg","first-page":"855","article-title":"Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms","volume":"106","author":"Coert BA","year":"2007","unstructured":"Coert BA, Chang SD, Do HM, Marks MP, Steinberg GK. Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms. J Neurosurg. 2007;106(5):855\u2013865. doi:10.3171\/jns.2007.106.5.855"},{"issue":"1","key":"b2","series-title":"Stroke","first-page":"100","article-title":"Endovascular treatment of ruptured posterior circulation cerebral aneurysms. Clinical and angiographic outcomes","volume":"31","author":"Lempert TE","year":"2000","unstructured":"Lempert TE, Malek AM, Halbach VV, Endovascular treatment of ruptured posterior circulation cerebral aneurysms. Clinical and angiographic outcomes. Stroke. 2000;31(1):100\u2013110. doi:10.1161\/01.str.31.1.100"},{"issue":"1","key":"b3","series-title":"Neurosurgery","first-page":"14","article-title":"Clinical and radiographic outcome in the management of posterior circulation aneurysms by use of direct surgical or endovascular techniques","volume":"51","author":"Ogilvy CS","year":"2002","unstructured":"Ogilvy CS, Hoh BL, Singer RJ, Putman CM. Clinical and radiographic outcome in the management of posterior circulation aneurysms by use of direct surgical or endovascular techniques. Neurosurgery. 2002;51(1):14\u201322. doi:10.1097\/00006123-200207000-00003"},{"issue":"4","key":"b4","series-title":"Neurosurgery","first-page":"626","article-title":"Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience","volume":"60","author":"Pandey AS","year":"2007","unstructured":"Pandey AS, Koebbe C, Rosenwasser RH, Veznedaroglu E. Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience. Neurosurgery. 2007;60(4):626\u2013637. doi:10.1227\/01.NEU.0000255433.47044.8F"},{"issue":"6","key":"b5","series-title":"Neurosurgery","first-page":"1236","article-title":"The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era","volume":"62","author":"Sanai N","year":"2008","unstructured":"Sanai N, Tarapore P, Lee AC, Lawton MT. The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era. Neurosurgery. 2008;62(6):1236\u20131253. doi:10.1227\/01.neu.0000333295.59738.de"},{"issue":"5","key":"b6","series-title":"Acta Neurochir (Wien)","first-page":"1527","article-title":"Endovascular embolization versus surgical clipping in a single surgeon series of basilar artery aneurysms: a complementary approach in the endovascular era","volume":"163","author":"Winkler EA","year":"2021","unstructured":"Winkler EA, Lee A, Yue JK, Endovascular embolization versus surgical clipping in a single surgeon series of basilar artery aneurysms: a complementary approach in the endovascular era. Acta Neurochir (Wien). 2021;163(5):1527\u20131540. doi:10.1007\/s00701-021-04803-5"},{"key":"b7","series-title":"World Neurosurg","first-page":"1089","article-title":"Endovascular treatment for ruptured intracranial posterior circulation aneurysms: complications and clinical outcomes","volume":"193","author":"Yang J","year":"2025","unstructured":"Yang J, Wu Q, Ji Z, Endovascular treatment for ruptured intracranial posterior circulation aneurysms: complications and clinical outcomes. World Neurosurg. 2025;193:1089\u20131098. doi:10.1016\/j.wneu.2024.09.067"},{"issue":"9969","key":"b8","series-title":"Lancet","first-page":"691","article-title":"The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT)","volume":"385","author":"Molyneux AJ","year":"2015","unstructured":"Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RS. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet. 2015;385(9969):691\u2013697. doi:10.1016\/S0140-6736(14)60975-2"},{"issue":"3","key":"b9","series-title":"J Neurosurg","first-page":"771","article-title":"Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial","volume":"132","author":"Spetzler RF","year":"2020","unstructured":"Spetzler RF, McDougall CG, Zabramski JM, Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurg. 2020;132(3):771\u2013776. doi:10.3171\/2018.8.JNS181846"},{"issue":"3","key":"b10","series-title":"J Neurosurg","first-page":"609","article-title":"The Barrow Ruptured Aneurysm Trial: 6-year results","volume":"123","author":"Spetzler RF","year":"2015","unstructured":"Spetzler RF, McDougall CG, Zabramski JM, The Barrow Ruptured Aneurysm Trial: 6-year results. J Neurosurg. 2015;123(3):609\u2013617. doi:10.3171\/2014.9.JNS141749"},{"issue":"5","key":"b11","series-title":"Neurosurgery","first-page":"622","article-title":"Analysis of wide-neck aneurysms in the Barrow Ruptured Aneurysm Trial","volume":"85","author":"Mascitelli JR","year":"2019","unstructured":"Mascitelli JR, Lawton MT, Hendricks BK, Nakaji P, Zabramski JM, Spetzler RF. Analysis of wide-neck aneurysms in the Barrow Ruptured Aneurysm Trial. Neurosurgery. 2019;85(5):622\u2013631. doi:10.1093\/neuros\/nyy439"},{"issue":"1","key":"b12","series-title":"J Neurosurg","first-page":"135","article-title":"The Barrow Ruptured Aneurysm Trial","volume":"116","author":"McDougall CG","year":"2012","unstructured":"McDougall CG, Spetzler RF, Zabramski JM, The Barrow Ruptured Aneurysm Trial. J Neurosurg. 2012;116(1):135\u2013144. doi:10.3171\/2011.8.JNS101767"},{"issue":"1","key":"b13","series-title":"J Neurosurg","first-page":"120","article-title":"Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial","volume":"128","author":"Spetzler RF","year":"2018","unstructured":"Spetzler RF, Zabramski JM, McDougall CG, Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurg. 2018;128(1):120\u2013125. doi:10.3171\/2016.9.JNS161301"},{"issue":"5","key":"b14","series-title":"World Neurosurg","first-page":"784","article-title":"Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: a comparison of endovascular and microsurgical clip ligation","volume":"83","author":"Bohnstedt BN","year":"2015","unstructured":"Bohnstedt BN, Ziemba-Davis M, Edwards G, Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: a comparison of endovascular and microsurgical clip ligation. World Neurosurg. 2015;83(5):784\u2013793. doi:10.1016\/j.wneu.2014.12.035"},{"issue":"7","key":"b15","series-title":"Neuroradiology","first-page":"877","article-title":"Stent-assisted coil embolization of wide-necked posterior inferior cerebellar artery aneurysms","volume":"55","author":"Cho YD","year":"2013","unstructured":"Cho YD, Kang HS, Lee WJ, Kim KM, Kim JE, Han MH. Stent-assisted coil embolization of wide-necked posterior inferior cerebellar artery aneurysms. Neuroradiology. 2013;55(7):877\u2013882. doi:10.1007\/s00234-013-1178-1"},{"issue":"5","key":"b16","series-title":"J Neurosurg","first-page":"991","article-title":"Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms","volume":"118","author":"Chalouhi N","year":"2013","unstructured":"Chalouhi N, Jabbour P, Starke RM, Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms. J Neurosurg. 2013;118(5):991\u2013999. doi:10.3171\/2012.12.JNS121240"},{"issue":"3","key":"b17","series-title":"Br J Neurosurg","first-page":"406","article-title":"Microsurgical management of posterior cerebral artery aneurysms: a report of thirty cases in modern era","volume":"29","author":"Wang WX","year":"2015","unstructured":"Wang WX, Xu BN, Wang FY, Wu C, Sun ZH. Microsurgical management of posterior cerebral artery aneurysms: a report of thirty cases in modern era. Br J Neurosurg. 2015;29(3):406\u2013412. doi:10.3109\/02688697.2015.1004301"},{"issue":"5","key":"b18","series-title":"J Neuroradiol","first-page":"291","article-title":"Treatment of dissecting aneurysms of the PICA: anatomical considerations and clinical outcome","volume":"42","author":"van den Berg R","year":"2015","unstructured":"van den Berg R, Doorschodt TC, Sprengers ME, Vandertop WP. Treatment of dissecting aneurysms of the PICA: anatomical considerations and clinical outcome. J Neuroradiol. 2015;42(5):291\u2013297. doi:10.1016\/j.neurad.2014.10.001"},{"issue":"4","key":"b19","series-title":"J Neurosurg","first-page":"468","article-title":"Aneurysms of the posterior cerebral artery","volume":"30","author":"Drake CG","year":"1969","unstructured":"Drake CG, Amacher AL. Aneurysms of the posterior cerebral artery. J Neurosurg. 1969;30(4):468\u2013474. doi:10.3171\/jns.1969.30.4.0468"},{"issue":"3-4","key":"b20","series-title":"Neurol Res","first-page":"361","article-title":"Temporo-polar approach to aneurysms of the basilar artery at and around the distal bifurcation: technical note","volume":"2","author":"Sano K","year":"1980","unstructured":"Sano K. Temporo-polar approach to aneurysms of the basilar artery at and around the distal bifurcation: technical note. Neurol Res. 1980;2(3-4):361\u2013367. doi:10.1080\/01616412.1980.11739588"},{"issue":"1","key":"b21","series-title":"Cureus","first-page":"e77856","article-title":"Microsurgery treatment as an optimal management of posterior cerebral artery aneurysms: a systematic review and meta-analysis","volume":"17","author":"Fotakopoulos G","year":"2025","unstructured":"Fotakopoulos G, Georgakopoulou VE, Gatos C, Christodoulidis G, Foroglou N. Microsurgery treatment as an optimal management of posterior cerebral artery aneurysms: a systematic review and meta-analysis. Cureus. 2025;17(1):e77856. doi:10.7759\/cureus.77856"},{"issue":"2","key":"b22","series-title":"AJNR Am J Neuroradiol","first-page":"300","article-title":"Endovascular treatment of posterior cerebral artery aneurysms","volume":"27","author":"van Rooij WJ","year":"2006","unstructured":"van Rooij WJ, Sluzewski M, Beute GN. Endovascular treatment of posterior cerebral artery aneurysms. AJNR Am J Neuroradiol. 2006;27(2):300\u2013305."},{"issue":"6","key":"b23","series-title":"Neurosurg Rev","first-page":"3595","article-title":"Natural history and management of posterior cerebral artery aneurysms: a systematic review and meta-analysis of individual patient data","volume":"45","author":"Essibayi MA","year":"2022","unstructured":"Essibayi MA, Oushy SH, Keser Z, Lanzino G. Natural history and management of posterior cerebral artery aneurysms: a systematic review and meta-analysis of individual patient data. Neurosurg Rev. 2022;45(6):3595\u20133608. doi:10.1007\/s10143-022-01867-4"},{"issue":"6","key":"b24","series-title":"Neurosurgery","first-page":"908","article-title":"The superior cerebellar artery aneurysm: a posterior circulation aneurysm with favorable microsurgical outcomes","volume":"80","author":"Rodr\u00edguez-Hern\u00e1ndez A","year":"2017","unstructured":"Rodr\u00edguez-Hern\u00e1ndez A, Walcott BP, Birk H, Lawton MT. The superior cerebellar artery aneurysm: a posterior circulation aneurysm with favorable microsurgical outcomes. Neurosurgery. 2017;80(6):908\u2013916."},{"issue":"1","key":"b25","series-title":"Asian J Neurosurg","first-page":"47","article-title":"Microsurgical management of aneurysms of the superior cerebellar artery - lessons learnt: An experience of 14 consecutive cases and review of the literature","volume":"10","author":"Nair P","year":"2015","unstructured":"Nair P, Panikar D, Nair AP, Sundar S, Ayiramuthu P, Thomas A. Microsurgical management of aneurysms of the superior cerebellar artery - lessons learnt: An experience of 14 consecutive cases and review of the literature. Asian J Neurosurg. 2015;10(1):47. doi:10.4103\/1793-5482.151513"},{"key":"b26","series-title":"World Neurosurg","first-page":"229","article-title":"Superior cerebellar artery aneurysms, the \"sui generis\" in posterior circulation: the role of microsurgery in the endovascular era","volume":"94","author":"Patra DP","year":"2016","unstructured":"Patra DP, Bir SC, Maiti TK, Superior cerebellar artery aneurysms, the \"sui generis\" in posterior circulation: the role of microsurgery in the endovascular era. World Neurosurg. 2016;94:229\u2013238. doi:10.1016\/j.wneu.2016.07.007"},{"issue":"1","key":"b27","series-title":"Neurosurgery","first-page":"10","article-title":"Microsurgical anatomy of the superior cerebellar artery","volume":"6","author":"Hardy DG","year":"1980","unstructured":"Hardy DG, Peace DA, Rhoton AL Jr. Microsurgical anatomy of the superior cerebellar artery. Neurosurgery. 1980;6(1):10\u201328. doi:10.1227\/00006123-198001000-00002"},{"issue":"2","key":"b28","series-title":"J Neurosurg","first-page":"393","article-title":"Vertebrobasilar dissecting aneurysms: microsurgical management in 42 patients","volume":"137","author":"Frisoli FA","year":"2022","unstructured":"Frisoli FA, Srinivasan VM, Catapano JS, Vertebrobasilar dissecting aneurysms: microsurgical management in 42 patients. J Neurosurg. 2022;137(2):393\u2013401. doi:10.3171\/2021.9.JNS21397"},{"key":"b29","series-title":"Surg Neurol Int","first-page":"227","article-title":"Vertebral artery and posterior inferior cerebellar artery aneurysms: results of microsurgical treatment of eighty patients","volume":"10","author":"Pilipenko Y","year":"2019","unstructured":"Pilipenko Y, Eliava S, Okishev D, Okisheva E, Spyrou A. Vertebral artery and posterior inferior cerebellar artery aneurysms: results of microsurgical treatment of eighty patients. Surg Neurol Int. 2019;10:227. doi:10.25259\/SNI_326_2019"},{"issue":"2","key":"b30","series-title":"World Neurosurg","first-page":"380","article-title":"Intracranial vertebral artery aneurysms: clinical features and outcome of 190 patients","volume":"84","author":"Lehto H","year":"2015","unstructured":"Lehto H, Niemel\u00e4 M, Kivisaari R, Intracranial vertebral artery aneurysms: clinical features and outcome of 190 patients. World Neurosurg. 2015;84(2):380\u2013389. doi:10.1016\/j.wneu.2015.03.034"},{"issue":"2","key":"b31","series-title":"Surg Neurol","first-page":"190","article-title":"Microsurgical anatomy of the perforating branches of the vertebral artery","volume":"61","author":"Marinkovic S","year":"2004","unstructured":"Marinkovic S, Milisavljevic M, Gibo H, Malikovic A, Djulejic V. Microsurgical anatomy of the perforating branches of the vertebral artery. Surg Neurol. 2004;61(2):190\u2013197."},{"key":"b32","series-title":"Front Neurol","first-page":"728176","article-title":"Microsurgical treatment strategy of vertebral artery fusiform aneurysm-from the standpoint of hemodynamic integrity and perforator preservation","volume":"12","author":"Tsunoda S","year":"2021","unstructured":"Tsunoda S, Inoue T. Microsurgical treatment strategy of vertebral artery fusiform aneurysm-from the standpoint of hemodynamic integrity and perforator preservation. Front Neurol. 2021;12:728176. doi:10.3389\/fneur.2021.728176"},{"issue":"6","key":"b33","series-title":"Acta Neurochir (Wien)","first-page":"1087","article-title":"Surgical management of vertebral and basilar artery aneurysms: a single center experience in 41 patients","volume":"155","author":"Shi X","year":"2013","unstructured":"Shi X, Qian H, Singh KCKI, Surgical management of vertebral and basilar artery aneurysms: a single center experience in 41 patients. Acta Neurochir (Wien). 2013;155(6):1087\u20131093. doi:10.1007\/s00701-013-1656-6"},{"issue":"1-2","key":"b34","series-title":"World Neurosurg","first-page":"118","article-title":"Microsurgical management of basilar artery apex aneurysms: a single surgeon\u2019s experience from Louisiana State University, Shreveport","volume":"82","author":"Nanda A","year":"2014","unstructured":"Nanda A, Sonig A, Banerjee AD, Javalkar VK. Microsurgical management of basilar artery apex aneurysms: a single surgeon\u2019s experience from Louisiana State University, Shreveport. World Neurosurg. 2014;82(1-2):118\u2013129. doi:10.1016\/j.wneu.2013.06.016"},{"issue":"2","key":"b35","series-title":"Neurosurgery","first-page":"284","article-title":"Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients","volume":"72","author":"Sekhar LN","year":"2013","unstructured":"Sekhar LN, Tariq F, Morton RP, Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients. Neurosurgery. 2013;72(2):284\u2013299. doi:10.1227\/NEU.0b013e3182797952"},{"issue":"Suppl 3","key":"b36","series-title":"Neurosurgery","first-page":"387","article-title":"Long-term patient outcomes after microsurgical treatment of blister-like aneurysms of the basilar artery","volume":"11","author":"Mooney MA","year":"2015","unstructured":"Mooney MA, Kalani MYS, Nakaji P, Long-term patient outcomes after microsurgical treatment of blister-like aneurysms of the basilar artery. Neurosurgery. 2015;11Suppl 3:387\u2013393. doi:10.1227\/NEU.0000000000000866"},{"key":"b37","series-title":"World Neurosurg","first-page":"305","article-title":"Microsurgical clipping of basilar apex aneurysms: a systematic historical review of approaches and their results","volume":"114","author":"Spiessberger A","year":"2018","unstructured":"Spiessberger A, Strange F, Fandino J, Marbacher S. Microsurgical clipping of basilar apex aneurysms: a systematic historical review of approaches and their results. World Neurosurg. 2018;114:305\u2013316. doi:10.1016\/j.wneu.2018.03.141"},{"issue":"1","key":"b38","series-title":"Neurosurgery","first-page":"83","article-title":"Bypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress","volume":"79","author":"Lawton MT","year":"2016","unstructured":"Lawton MT, Abla AA, Rutledge WC, Bypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress. Neurosurgery. 2016;79(1):83\u201399. doi:10.1227\/NEU.0000000000001175"},{"issue":"7","key":"b39","series-title":"Stroke","first-page":"1958","article-title":"Lifelong rupture risk of intracranial aneurysms depends on risk factors: a prospective Finnish cohort study","volume":"45","author":"Korja M","year":"2014","unstructured":"Korja M, Lehto H, Juvela S. Lifelong rupture risk of intracranial aneurysms depends on risk factors: a prospective Finnish cohort study. Stroke. 2014;45(7):1958\u201363. doi:10.1161\/STROKEAHA.114.005318"},{"issue":"5","key":"b1","series-title":"J Neurosurg","first-page":"855","article-title":"Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms","volume":"106","author":"Coert BA","year":"2007","unstructured":"Coert BA, Chang SD, Do HM, Marks MP, Steinberg GK. Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms. J Neurosurg. 2007;106(5):855\u2013865. doi:10.3171\/jns.2007.106.5.855"},{"issue":"1","key":"b2","series-title":"Stroke","first-page":"100","article-title":"Endovascular treatment of ruptured posterior circulation cerebral aneurysms. Clinical and angiographic outcomes","volume":"31","author":"Lempert TE","year":"2000","unstructured":"Lempert TE, Malek AM, Halbach VV, Endovascular treatment of ruptured posterior circulation cerebral aneurysms. Clinical and angiographic outcomes. Stroke. 2000;31(1):100\u2013110. doi:10.1161\/01.str.31.1.100"},{"issue":"1","key":"b3","series-title":"Neurosurgery","first-page":"14","article-title":"Clinical and radiographic outcome in the management of posterior circulation aneurysms by use of direct surgical or endovascular techniques","volume":"51","author":"Ogilvy CS","year":"2002","unstructured":"Ogilvy CS, Hoh BL, Singer RJ, Putman CM. Clinical and radiographic outcome in the management of posterior circulation aneurysms by use of direct surgical or endovascular techniques. Neurosurgery. 2002;51(1):14\u201322. doi:10.1097\/00006123-200207000-00003"},{"issue":"4","key":"b4","series-title":"Neurosurgery","first-page":"626","article-title":"Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience","volume":"60","author":"Pandey AS","year":"2007","unstructured":"Pandey AS, Koebbe C, Rosenwasser RH, Veznedaroglu E. Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience. Neurosurgery. 2007;60(4):626\u2013637. doi:10.1227\/01.NEU.0000255433.47044.8F"},{"issue":"6","key":"b5","series-title":"Neurosurgery","first-page":"1236","article-title":"The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era","volume":"62","author":"Sanai N","year":"2008","unstructured":"Sanai N, Tarapore P, Lee AC, Lawton MT. The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era. Neurosurgery. 2008;62(6):1236\u20131253. doi:10.1227\/01.neu.0000333295.59738.de"},{"issue":"5","key":"b6","series-title":"Acta Neurochir (Wien)","first-page":"1527","article-title":"Endovascular embolization versus surgical clipping in a single surgeon series of basilar artery aneurysms: a complementary approach in the endovascular era","volume":"163","author":"Winkler EA","year":"2021","unstructured":"Winkler EA, Lee A, Yue JK, Endovascular embolization versus surgical clipping in a single surgeon series of basilar artery aneurysms: a complementary approach in the endovascular era. Acta Neurochir (Wien). 2021;163(5):1527\u20131540. doi:10.1007\/s00701-021-04803-5"},{"key":"b7","series-title":"World Neurosurg","first-page":"1089","article-title":"Endovascular treatment for ruptured intracranial posterior circulation aneurysms: complications and clinical outcomes","volume":"193","author":"Yang J","year":"2025","unstructured":"Yang J, Wu Q, Ji Z, Endovascular treatment for ruptured intracranial posterior circulation aneurysms: complications and clinical outcomes. World Neurosurg. 2025;193:1089\u20131098. doi:10.1016\/j.wneu.2024.09.067"},{"issue":"9969","key":"b8","series-title":"Lancet","first-page":"691","article-title":"The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT)","volume":"385","author":"Molyneux AJ","year":"2015","unstructured":"Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RS. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet. 2015;385(9969):691\u2013697. doi:10.1016\/S0140-6736(14)60975-2"},{"issue":"3","key":"b9","series-title":"J Neurosurg","first-page":"771","article-title":"Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial","volume":"132","author":"Spetzler RF","year":"2020","unstructured":"Spetzler RF, McDougall CG, Zabramski JM, Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurg. 2020;132(3):771\u2013776. doi:10.3171\/2018.8.JNS181846"},{"issue":"3","key":"b10","series-title":"J Neurosurg","first-page":"609","article-title":"The Barrow Ruptured Aneurysm Trial: 6-year results","volume":"123","author":"Spetzler RF","year":"2015","unstructured":"Spetzler RF, McDougall CG, Zabramski JM, The Barrow Ruptured Aneurysm Trial: 6-year results. J Neurosurg. 2015;123(3):609\u2013617. doi:10.3171\/2014.9.JNS141749"},{"issue":"5","key":"b11","series-title":"Neurosurgery","first-page":"622","article-title":"Analysis of wide-neck aneurysms in the Barrow Ruptured Aneurysm Trial","volume":"85","author":"Mascitelli JR","year":"2019","unstructured":"Mascitelli JR, Lawton MT, Hendricks BK, Nakaji P, Zabramski JM, Spetzler RF. Analysis of wide-neck aneurysms in the Barrow Ruptured Aneurysm Trial. Neurosurgery. 2019;85(5):622\u2013631. doi:10.1093\/neuros\/nyy439"},{"issue":"1","key":"b12","series-title":"J Neurosurg","first-page":"135","article-title":"The Barrow Ruptured Aneurysm Trial","volume":"116","author":"McDougall CG","year":"2012","unstructured":"McDougall CG, Spetzler RF, Zabramski JM, The Barrow Ruptured Aneurysm Trial. J Neurosurg. 2012;116(1):135\u2013144. doi:10.3171\/2011.8.JNS101767"},{"issue":"1","key":"b13","series-title":"J Neurosurg","first-page":"120","article-title":"Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial","volume":"128","author":"Spetzler RF","year":"2018","unstructured":"Spetzler RF, Zabramski JM, McDougall CG, Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurg. 2018;128(1):120\u2013125. doi:10.3171\/2016.9.JNS161301"},{"issue":"5","key":"b14","series-title":"World Neurosurg","first-page":"784","article-title":"Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: a comparison of endovascular and microsurgical clip ligation","volume":"83","author":"Bohnstedt BN","year":"2015","unstructured":"Bohnstedt BN, Ziemba-Davis M, Edwards G, Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: a comparison of endovascular and microsurgical clip ligation. World Neurosurg. 2015;83(5):784\u2013793. doi:10.1016\/j.wneu.2014.12.035"},{"issue":"7","key":"b15","series-title":"Neuroradiology","first-page":"877","article-title":"Stent-assisted coil embolization of wide-necked posterior inferior cerebellar artery aneurysms","volume":"55","author":"Cho YD","year":"2013","unstructured":"Cho YD, Kang HS, Lee WJ, Kim KM, Kim JE, Han MH. Stent-assisted coil embolization of wide-necked posterior inferior cerebellar artery aneurysms. Neuroradiology. 2013;55(7):877\u2013882. doi:10.1007\/s00234-013-1178-1"},{"issue":"5","key":"b16","series-title":"J Neurosurg","first-page":"991","article-title":"Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms","volume":"118","author":"Chalouhi N","year":"2013","unstructured":"Chalouhi N, Jabbour P, Starke RM, Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms. J Neurosurg. 2013;118(5):991\u2013999. doi:10.3171\/2012.12.JNS121240"},{"issue":"3","key":"b17","series-title":"Br J Neurosurg","first-page":"406","article-title":"Microsurgical management of posterior cerebral artery aneurysms: a report of thirty cases in modern era","volume":"29","author":"Wang WX","year":"2015","unstructured":"Wang WX, Xu BN, Wang FY, Wu C, Sun ZH. Microsurgical management of posterior cerebral artery aneurysms: a report of thirty cases in modern era. Br J Neurosurg. 2015;29(3):406\u2013412. doi:10.3109\/02688697.2015.1004301"},{"issue":"5","key":"b18","series-title":"J Neuroradiol","first-page":"291","article-title":"Treatment of dissecting aneurysms of the PICA: anatomical considerations and clinical outcome","volume":"42","author":"van den Berg R","year":"2015","unstructured":"van den Berg R, Doorschodt TC, Sprengers ME, Vandertop WP. Treatment of dissecting aneurysms of the PICA: anatomical considerations and clinical outcome. J Neuroradiol. 2015;42(5):291\u2013297. doi:10.1016\/j.neurad.2014.10.001"},{"issue":"4","key":"b19","series-title":"J Neurosurg","first-page":"468","article-title":"Aneurysms of the posterior cerebral artery","volume":"30","author":"Drake CG","year":"1969","unstructured":"Drake CG, Amacher AL. Aneurysms of the posterior cerebral artery. J Neurosurg. 1969;30(4):468\u2013474. doi:10.3171\/jns.1969.30.4.0468"},{"issue":"3-4","key":"b20","series-title":"Neurol Res","first-page":"361","article-title":"Temporo-polar approach to aneurysms of the basilar artery at and around the distal bifurcation: technical note","volume":"2","author":"Sano K","year":"1980","unstructured":"Sano K. Temporo-polar approach to aneurysms of the basilar artery at and around the distal bifurcation: technical note. Neurol Res. 1980;2(3-4):361\u2013367. doi:10.1080\/01616412.1980.11739588"},{"issue":"1","key":"b21","series-title":"Cureus","first-page":"e77856","article-title":"Microsurgery treatment as an optimal management of posterior cerebral artery aneurysms: a systematic review and meta-analysis","volume":"17","author":"Fotakopoulos G","year":"2025","unstructured":"Fotakopoulos G, Georgakopoulou VE, Gatos C, Christodoulidis G, Foroglou N. Microsurgery treatment as an optimal management of posterior cerebral artery aneurysms: a systematic review and meta-analysis. Cureus. 2025;17(1):e77856. doi:10.7759\/cureus.77856"},{"issue":"2","key":"b22","series-title":"AJNR Am J Neuroradiol","first-page":"300","article-title":"Endovascular treatment of posterior cerebral artery aneurysms","volume":"27","author":"van Rooij WJ","year":"2006","unstructured":"van Rooij WJ, Sluzewski M, Beute GN. Endovascular treatment of posterior cerebral artery aneurysms. AJNR Am J Neuroradiol. 2006;27(2):300\u2013305."},{"issue":"6","key":"b23","series-title":"Neurosurg Rev","first-page":"3595","article-title":"Natural history and management of posterior cerebral artery aneurysms: a systematic review and meta-analysis of individual patient data","volume":"45","author":"Essibayi MA","year":"2022","unstructured":"Essibayi MA, Oushy SH, Keser Z, Lanzino G. Natural history and management of posterior cerebral artery aneurysms: a systematic review and meta-analysis of individual patient data. Neurosurg Rev. 2022;45(6):3595\u20133608. doi:10.1007\/s10143-022-01867-4"},{"issue":"6","key":"b24","series-title":"Neurosurgery","first-page":"908","article-title":"The superior cerebellar artery aneurysm: a posterior circulation aneurysm with favorable microsurgical outcomes","volume":"80","author":"Rodr\u00edguez-Hern\u00e1ndez A","year":"2017","unstructured":"Rodr\u00edguez-Hern\u00e1ndez A, Walcott BP, Birk H, Lawton MT. The superior cerebellar artery aneurysm: a posterior circulation aneurysm with favorable microsurgical outcomes. Neurosurgery. 2017;80(6):908\u2013916."},{"issue":"1","key":"b25","series-title":"Asian J Neurosurg","first-page":"47","article-title":"Microsurgical management of aneurysms of the superior cerebellar artery - lessons learnt: An experience of 14 consecutive cases and review of the literature","volume":"10","author":"Nair P","year":"2015","unstructured":"Nair P, Panikar D, Nair AP, Sundar S, Ayiramuthu P, Thomas A. Microsurgical management of aneurysms of the superior cerebellar artery - lessons learnt: An experience of 14 consecutive cases and review of the literature. Asian J Neurosurg. 2015;10(1):47. doi:10.4103\/1793-5482.151513"},{"key":"b26","series-title":"World Neurosurg","first-page":"229","article-title":"Superior cerebellar artery aneurysms, the \"sui generis\" in posterior circulation: the role of microsurgery in the endovascular era","volume":"94","author":"Patra DP","year":"2016","unstructured":"Patra DP, Bir SC, Maiti TK, Superior cerebellar artery aneurysms, the \"sui generis\" in posterior circulation: the role of microsurgery in the endovascular era. World Neurosurg. 2016;94:229\u2013238. doi:10.1016\/j.wneu.2016.07.007"},{"issue":"1","key":"b27","series-title":"Neurosurgery","first-page":"10","article-title":"Microsurgical anatomy of the superior cerebellar artery","volume":"6","author":"Hardy DG","year":"1980","unstructured":"Hardy DG, Peace DA, Rhoton AL Jr. Microsurgical anatomy of the superior cerebellar artery. Neurosurgery. 1980;6(1):10\u201328. doi:10.1227\/00006123-198001000-00002"},{"issue":"2","key":"b28","series-title":"J Neurosurg","first-page":"393","article-title":"Vertebrobasilar dissecting aneurysms: microsurgical management in 42 patients","volume":"137","author":"Frisoli FA","year":"2022","unstructured":"Frisoli FA, Srinivasan VM, Catapano JS, Vertebrobasilar dissecting aneurysms: microsurgical management in 42 patients. J Neurosurg. 2022;137(2):393\u2013401. doi:10.3171\/2021.9.JNS21397"},{"key":"b29","series-title":"Surg Neurol Int","first-page":"227","article-title":"Vertebral artery and posterior inferior cerebellar artery aneurysms: results of microsurgical treatment of eighty patients","volume":"10","author":"Pilipenko Y","year":"2019","unstructured":"Pilipenko Y, Eliava S, Okishev D, Okisheva E, Spyrou A. Vertebral artery and posterior inferior cerebellar artery aneurysms: results of microsurgical treatment of eighty patients. Surg Neurol Int. 2019;10:227. doi:10.25259\/SNI_326_2019"},{"issue":"2","key":"b30","series-title":"World Neurosurg","first-page":"380","article-title":"Intracranial vertebral artery aneurysms: clinical features and outcome of 190 patients","volume":"84","author":"Lehto H","year":"2015","unstructured":"Lehto H, Niemel\u00e4 M, Kivisaari R, Intracranial vertebral artery aneurysms: clinical features and outcome of 190 patients. World Neurosurg. 2015;84(2):380\u2013389. doi:10.1016\/j.wneu.2015.03.034"},{"issue":"2","key":"b31","series-title":"Surg Neurol","first-page":"190","article-title":"Microsurgical anatomy of the perforating branches of the vertebral artery","volume":"61","author":"Marinkovic S","year":"2004","unstructured":"Marinkovic S, Milisavljevic M, Gibo H, Malikovic A, Djulejic V. Microsurgical anatomy of the perforating branches of the vertebral artery. Surg Neurol. 2004;61(2):190\u2013197."},{"key":"b32","series-title":"Front Neurol","first-page":"728176","article-title":"Microsurgical treatment strategy of vertebral artery fusiform aneurysm-from the standpoint of hemodynamic integrity and perforator preservation","volume":"12","author":"Tsunoda S","year":"2021","unstructured":"Tsunoda S, Inoue T. Microsurgical treatment strategy of vertebral artery fusiform aneurysm-from the standpoint of hemodynamic integrity and perforator preservation. Front Neurol. 2021;12:728176. doi:10.3389\/fneur.2021.728176"},{"issue":"6","key":"b33","series-title":"Acta Neurochir (Wien)","first-page":"1087","article-title":"Surgical management of vertebral and basilar artery aneurysms: a single center experience in 41 patients","volume":"155","author":"Shi X","year":"2013","unstructured":"Shi X, Qian H, Singh KCKI, Surgical management of vertebral and basilar artery aneurysms: a single center experience in 41 patients. Acta Neurochir (Wien). 2013;155(6):1087\u20131093. doi:10.1007\/s00701-013-1656-6"},{"issue":"1-2","key":"b34","series-title":"World Neurosurg","first-page":"118","article-title":"Microsurgical management of basilar artery apex aneurysms: a single surgeon\u2019s experience from Louisiana State University, Shreveport","volume":"82","author":"Nanda A","year":"2014","unstructured":"Nanda A, Sonig A, Banerjee AD, Javalkar VK. Microsurgical management of basilar artery apex aneurysms: a single surgeon\u2019s experience from Louisiana State University, Shreveport. World Neurosurg. 2014;82(1-2):118\u2013129. doi:10.1016\/j.wneu.2013.06.016"},{"issue":"2","key":"b35","series-title":"Neurosurgery","first-page":"284","article-title":"Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients","volume":"72","author":"Sekhar LN","year":"2013","unstructured":"Sekhar LN, Tariq F, Morton RP, Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients. Neurosurgery. 2013;72(2):284\u2013299. doi:10.1227\/NEU.0b013e3182797952"},{"issue":"Suppl 3","key":"b36","series-title":"Neurosurgery","first-page":"387","article-title":"Long-term patient outcomes after microsurgical treatment of blister-like aneurysms of the basilar artery","volume":"11","author":"Mooney MA","year":"2015","unstructured":"Mooney MA, Kalani MYS, Nakaji P, Long-term patient outcomes after microsurgical treatment of blister-like aneurysms of the basilar artery. Neurosurgery. 2015;11Suppl 3:387\u2013393. doi:10.1227\/NEU.0000000000000866"},{"key":"b37","series-title":"World Neurosurg","first-page":"305","article-title":"Microsurgical clipping of basilar apex aneurysms: a systematic historical review of approaches and their results","volume":"114","author":"Spiessberger A","year":"2018","unstructured":"Spiessberger A, Strange F, Fandino J, Marbacher S. Microsurgical clipping of basilar apex aneurysms: a systematic historical review of approaches and their results. World Neurosurg. 2018;114:305\u2013316. doi:10.1016\/j.wneu.2018.03.141"},{"issue":"1","key":"b38","series-title":"Neurosurgery","first-page":"83","article-title":"Bypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress","volume":"79","author":"Lawton MT","year":"2016","unstructured":"Lawton MT, Abla AA, Rutledge WC, Bypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress. Neurosurgery. 2016;79(1):83\u201399. doi:10.1227\/NEU.0000000000001175"},{"issue":"7","key":"b39","series-title":"Stroke","first-page":"1958","article-title":"Lifelong rupture risk of intracranial aneurysms depends on risk factors: a prospective Finnish cohort study","volume":"45","author":"Korja M","year":"2014","unstructured":"Korja M, Lehto H, Juvela S. Lifelong rupture risk of intracranial aneurysms depends on risk factors: a prospective Finnish cohort study. Stroke. 2014;45(7):1958\u201363. doi:10.1161\/STROKEAHA.114.005318"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/59\/6\/article-pE16.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/59\/6\/article-pE16.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/59\/6\/article-pE16.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:16:25Z","timestamp":1780128985000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/59\/6\/article-pE16.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":78,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.9.focus25762","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}