Microsurgical Management of Large Superior Hypophyseal Artery Aneurysm Presented with Visual Impairment

Superior hypophyseal artery aneurysms are rare. Symptomatic superior hypophyseal artery aneurysm commonly presents with subarachnoid hemorrhage, uncommonly with cranial nerve deficits, and very rarely with visual impairment. Microsurgical management of such aneurysms is quite complex considering the anatomical structures in the paraclinoid region. A 43-year male presented with decreased visual acuity in both eyes. The patient was diagnosed with left supraclinoid partially thrombosed unruptured aneurysm with mass effect over optic chiasm and optic nerves on magnetic resonance imaging of the brain. He underwent clipping of the aneurysm with an aneurysmectomy. At the six-month clinical follow-up, the right eye vision had significantly improved.