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Objective To retrospectively analyze effective methods for surgical management of posterior circulation aneurysms. Methods There were 42 patients with posterior circulation aneurysms [26 cases of basilar aneurysm (27 aneurysms), 16 cases of vertebral aneurysm (17 aneurysms)]. There were 15 patients underwent bypass surgery [4 external carotid artery ⁃ P2 segment of posterior cerebral artery (ECA ⁃ P2), 2 internal carotid artery ⁃ P2 segment of posterior cerebral artery (ICA ⁃ P2), 2 internal maxillary artery⁃P2 segment of posterior cerebral artery (IMA⁃P2), 2 intracranial segment of vertebral artery⁃extracranial segment of vertebral artery, 5 occipital artery⁃posterior inferior cerebellar artery (OA⁃PICA)] and 27 patients underwent simple surgical clipping. Results Activities of daily life of 37 patients recovered to normal (14 patients with aneurysm on the top of basilar artery, 3 with aneurysm on the trunk of basilar artery, 9 with vertebral aneurysm, 5 with posterior inferior cerebellar artery aneurysm, 4 with aneurysm on the junction of P1-P2 segment of posterior cerebral artery, 1 with superior cerebellar artery, and 1 with anterior inferior cerebellar aneurysm). None of them occurred operation ⁃ related neurological dysfunction. The recovery rate was 88.09% . Among the other patients, 1 with aneurysm on the top of basilar artery presented severe signs and symptoms of neurological defect and cannot take care of oneself, 2 patients (1 with aneurysm on the top of basilar artery, 1 with aneurysm on the trunk of basilar artery) occurred brain stem hemorrhage after operation, and died at perioperative period, 2 with vertebral aneurysm relapsed and was cured after treatment. Conclusion Posterior circulation aneurysm which is not suitable for surgical clipping can be treated with intra⁃ and extra⁃cranial vessel bypass. It may avoid the risk of surgical clipping of aneurysm. DOI：10.3969/j.issn.1672⁃6731.2012.01.011