Paraclinoid aneurysm is defined as an aneurysm that originates at the internal carotid artery (ICA) distal to the proximal dural ring (PDR) and proximal to the posterior communicating artery (PCoA), which means both ophthalmic and clinoidal segments of the ICA. Patients with these aneurysms present with retro-orbital or supraorbital pain and varying degrees of visual field constriction and/or visual acuity decline which is associated with compression of optic nerve. This nerve is typically pushed superiorly and medially, which manifests as a unilateral inferomedial (lower nasal) quadrantanopsia . In addition, paraclinoid aneurysms may manifest as progressive diplopia due to compression of the cranial nerves involved in ocular movement caused by aneurysm growth. Unruptured paraclinoid aneurysm has a low risk of rupture compared to other types of cerebral aneurysm. The surgical indications for unruptured paraclinoid aneurysm should consider this low rupture risk as well as several other factors such as the aneurysm shape, the aneurysm size, and how old the patient.