Intracranial dolichoectasia mainly affects the posterior circulation in aging populations. It may develop into an aneurysmatic formation without a clear neck to be closed from circulation. These vertebrobasilar dolichoectatic artery aneurysms may lead to thromboembolic complications and mass effects on the brainstem and surrounding cranial nerves. Treatment is highly risky, especially in older patients with large or giant aneurysmatic formations. Vascular plasticity and collateral formation might stabilize aneurysmatic formation. The etiology and natural history behind this anomaly are unknown as are the best treatment options in different stages of the disease.