Background: Proximal basilar artery aneurysms are rare and when they occur they are often found in association with a fenestrated basilar artery. These lesions are often amenable to treatment by endovascular techniques Case Description: A 48-year-old woman with a proximal basilar artery aneurysm was treated by reconstructing the fenestrated basilar artery, placing two stents in an X-configuration, and subsequent coiling of the wide-necked aneurysm. The lesion was successfully coiled without new neurological deficit and there was no recanalization at 15 month follow-up. Conclusions: Reconstructing the fenestrated basilar artery with two stents in an X-configuration allows coiling of wide-necked aneurysms and is preferable to sacrificing a limb of the fenestrated basilar artery due to possibility of a physiologic significant branch off of the sacrificed limb. © 2010 Elsevier Inc.