The role of endovascular therapy for individual lesions is notclearly defined at this time; however, with continuing advances intechnology and analysis of long term results, a better understandingof the indications is being gained. In parallel with this trend,innovative approaches to the cranial base, sacrificing bone instead ofbrain retraction, have provided alternative strategies for the directsurgical management of difficult posterior circulation lesions (Smithet al., 2004). This work aimed at reviewing recent advances in surgical andnon surgical techniques in management of posterior circulationaneurysms with best indications in each type of management.