Iatrogenic pseudoaneurysm is a rare but serious event.

Natural history is unclear and no recommendations exist.

They mostly occur on the fourth segment of the internal carotid artery.

Conservative treatment seems to be an alternative in selected cases of patients.

Intracranial pseudoaneurysms are rare and account for less than 2% of all intracranial aneurysms. They most frequently occur after head injury, but they also can be caused by iatrogenic arterial injury during neurosurgical or ENT procedures. No clear guidelines are established concerning the treatment and surveillance of such aneurysms.

In this article, we present 2 cases of iatrogenic pseudoaneurysms treated conservatively and we propose a review of literature of the management and outcome of intracranial iatrogenic pseudoaneurysms.

The first case is one during a transcranial approach and the second one during a transsphenoidal approach, that were both conservatively treated with a close follow-up and a spontaneous healing of the aneurysm.

Endovascular treatment or surgical clipping are 2 valid therapeutic options in iatrogenic pseudoaneurysms, which should be preferred when feasible with a reasonable risk. In contrast, in case of a small pseudoaneurysm, important risk and complex procedures, conservative treatment with a close follow-up appears to be a valuable alternative.

Vascular

Pseudoaneurysm

Iatrogenic

Surgery

Endovascular

© 2025 The Author(s). Published by Elsevier Masson SAS.