Aneurysms of the vertebrobasilar system remain among the most challenging subsets of aneurysms to treat with an open surgical approach. Since Charles Drake’s pioneering work in the 1960s, several advances in microsurgical techniques have improved outcomes and feasibility in the open surgical management of these aneurysms. In parallel, the field of endovascular neurosurgery has provided several safe and effective treatment options. Multiple trials have suggested that endovascular therapy for aneurysms of the vertebrobasilar system is superior to open surgical management in most cases. In some instances, however, open surgical management likely represents a more effective and durable option relative to endovascular therapy. Therefore, continued training of future cerebrovascular specialists in open surgery of vertebrobasilar aneurysms remains crucial. With widespread utilization of endovascular techniques, however, proper exposure of trainees to such aneurysms is growing increasingly difficult. In this review, we discuss the recent advances in the endovascular management of vertebrobasilar aneurysms while also emphasizing the continued importance of open microneurosurgery in such cases.

椎基底动脉系统的动脉瘤仍然是最具有挑战性的动脉瘤亚组，需要通过开放手术方法进行治疗。自 1960 年代查尔斯·德雷克 (Charles Drake) 的开创性工作以来，显微外科技术的多项进步改善了这些动脉瘤开放式手术治疗的结果和可行性。与此同时，血管内神经外科领域提供了几种安全有效的治疗选择。多项试验表明，在大多数情况下，椎基底动脉系统动脉瘤的血管内治疗优于开放手术治疗。然而，在某些情况下，开放式手术治疗可能是比血管内治疗更有效和更持久的选择。所以，对未来的脑血管专家进行椎基底动脉瘤开放手术的持续培训仍然至关重要。然而，随着血管内技术的广泛应用，使受训者正确暴露于此类动脉瘤变得越来越困难。在这篇综述中，我们讨论了椎基底动脉瘤血管内治疗的最新进展，同时也强调了在这种情况下开放显微神经外科手术的持续重要性。