Objective: To report clinical outcomes of lower cranial nerve palsy (LCNP) caused by vertebral artery (VA) aneurysms. Methods: Seventy-two patients with VA aneurysms, who were treated endovascularly between 2001 and 2008, were retrospectively studied to identify patients presenting LCNP without hemorrhage. Results: LCNP occurred in 12 patients (16.7%) initially caused by VA aneurysms: four located at vertebral artery-posteroinferior cerebellar artery (PICA) complex, seven at distal to PICA segment and one at proximal to PICA segment. Among these patients, ten patients were diagnosed as having dissecting aneurysms of the intracranial VA, and two were diagnosed having saccular aneurysms. Two patients were treated by sole stent placement, five patients were treated by stent coil embolization and five were treated by vertebral artery occlusion. Nosocomial pneumonia did not occur in our patients. Post-operative LCNP resolved completely within 6 months in nine patients (75%) and within 9 months in ten patients (83%). Two (1.9%) patients died of aneurismal bleeding and brainstem ischemia, respectively. Conclusion: The results of this study can help to identify the effect and natural history of LCNP caused by VA aneurysms. These lesions can be effectively treated by endovascular embolization, even by VA occlusion.