Basilar artery aneurysm is a rare and difficult pathology that can require combination of various surgical methods. The authors present successful combined endovascular and microsurgical treatment of fusiform aneurysm of proximal basilar artery and confluence of vertebral arteries with high origin of the left posterior inferior cerebellar artery from aneurysm dome. The choice of preliminary revascularization of functionally significant artery involved in aneurysm and subsequent endovascular occlusion of aneurysm are considered.