Microsurgery and endovascular treatment have become the two main methods of treatment for intracranial aneurysms today. With advances in endovascular techniques and innovations in new embolic materials, endovascular therapy has become the treatment of choice for intracranial aneurysms in many medical centers. However, the best treatment for apical basilar artery aneurysms is still inconclusive. The only way for neurosurgeons to achieve better outcomes for these patients and to take their place in the surgical treatment of intracranial aneurysms is to continue to improve their microsurgical skills. The following is a typical case of an apical aneurysm of the basilar artery that was recently closed by microsurgery in our department: The patient was 40 years old, female, admitted with “spontaneous subarachnoid hemorrhage (Hunt-Hess grade III, Fisher grade III)” mainly due to “sudden loss of consciousness for more than 1 day”. DSA showed a high apical basilar artery aneurysm with irregular morphology. The patient recovered well after the procedure, and a repeat DSA showed satisfactory aneurysm clamping at one-third of the cost of interventional treatment.