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Introduction Subarachnoid hemorrhage (SAH) caused by posterior circulation perforator aneurysms is a rare clinical entity, often presenting with a benign early course but carrying uncertain long-term prognosis. Due to the rarity of this aneurysm subtype, follow-up data are extremely limited.Aim of study To analyze the long-term outcomes of patients with SAH from posterior circulation perforator aneurysms and determine whether follow-up findings should influence treatment strategies. This study also aims to compare outcomes with those reported in the literature for non-aneurysmal perimesencephalic hemorrhage, which shares similar early clinical features.Method Patient records were retrospectively reviewed from a single tertiary care center. Cases of subarachnoid hemorrhage were screened using radiological databases and clinical documentation to identify patients with confirmed posterior circulation perforator aneurysms. A total of 13 patients meeting inclusion criteria were analyzed. Patients received either endovascular treatment or conservative management. Follow-up data—spanning early (0–6 months), mid-term (6–24 months), and long-term (>24 months) intervals—will include modified Rankin Scale scores, rebleeding events, and major morbidity.Results Preliminary findings will explore outcome trends based on treatment modality and follow-up duration. Comparisons will be made with published long-term outcomes from non-aneurysmal perimesencephalic SAH to contextualize disease behavior and prognosis.Conclusion This is among the first studies to report long-term follow-up in patients with this rare SAH subtype. The results may help refine treatment decisions and provide insight into the natural course of this poorly understood condition.Conflict of Interest No