The treatment of 22 patients with vertebral artery injuries was reviewed. Only four patients required an emergency operation. Most of the injuries (13 of 22) were successfully managed by observation. Five patients were managed by angiographic embolization which was successful in three. In three patients with an aneurysm and arteriovenous fistula, proximal embolization of the vascular lesion was not adequate and a suboccipital craniectomy was required for distal ligation. Most vertebral artery injuries can safely be managed without an operation, or by angiographic embolization. Surgical intervention should be reserved for patients with severe bleeding or where embolization has failed.

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