Abstract
A patient in their 50s with a history of anxiety, depression, bipolar disorder, and insomnia presented with two to three weeks of progressive altered mental status, including delusions and hallucinations. Emergency Department workup included non-contrast CT, which disclosed a mass along the anterior midline of the sella. Contrast MRI and computed tomography angiography (CTA) demonstrated a large (17 mm) saccular aneurysm at the para‑ophthalmic segment of the right internal carotid artery, adjacent to the ophthalmic artery origin. In a single hybrid session, the team first performed endovascular balloon‑assisted proximal carotid occlusion, then converted to an external approach via a right frontotemporal craniotomy to clip the aneurysm neck under direct visualization. The patient tolerated the combined endovascular‑microsurgical procedure without intraoperative complications. Postoperatively, they experienced a single seizure on night one but recovered fully after antiepileptic adjustment. Visual acuity improved from 2/200 to 20/100, and the patient was discharged home in stable condition.