Conclusion and result

Following the procedure, the patient was received in a vitally stable condition in the recovery room, where he was initially drowsy but arousable and later shifted to a special care unit for further neurological monitoring. His drowsiness improved, and he was discharged as planned. Vertebral artery pseudoaneurysm and vertebro-sigmoid fistula formation are exceptionally rare complications of retro-sigmoid craniotomy. The patient’s positive early outcome highlights the critical importance of timely diagnosis and intervention to prevent further neurological deficits. Due to their rarity, these complications often lead to a delayed diagnosis. Advanced imaging techniques, like CT angiography or digital subtraction angiography, are crucial for finding and characterizing these lesions because traditional postoperative imaging may not always reveal such complex vascular problems. The successful management of this case through endovascular intervention with a covered stent exemplifies the effectiveness of contemporary neuroradiological techniques in maintaining vascular integrity and managing life-threatening conditions. It also emphasizes how crucial it is to closely monitor and follow up after neurosurgery, since early identification of complications can have a significant impact on the course of treatment. The short-term results of the reported case are satisfactory. However, long-term follow-up data to determine prognosis are still needed.