We report a case of symptomatic lateral medulla of brainstem compression secondary to vertebral artery (VA) dolichoectasia.The patient presented with unsteady gait for one year and slow speech, which progressed to ataxia and dysarthria.Neuroimages revealed dolichoectasia of vertebro-basilar artery with left medulla oblongata compression. The patient wasinformed about the therapeutic algorithm before starting treatment. When medication and physical therapy became ineffective,the patient was referred to a neurosurgeon, and a neurovascular decompression was consequently performed. Inour case, we pulled the ectatic vessel away from the brain stem and fi xed it to the nearby dura with unabsorbable silk. Satisfactorybrainstem decompression was achieved with subsequent neurological improvement. We discuss the rare etiologyof this case of symptomatic dolichoectasia and suggest surgical intervention to prevent progressive neurological sequelae