We compare the results of detachable coil embolization with those of surgical clipping in patients with posterior circulation aneurysms. Surgical procedure was performed in 31 patients (basilar tip: 13 cases, SCA: 8 cases, basilar trunk: 1 case, VA: 9 cases). Thirty one aneurysms were treated by embolization with Guglielmi detachable coil (GDC) and interlocking detachable coil (IDC) (basilar tip: 14 cases, SCA: 1 case, basilar trunk: 6 cases, VA: 10 cases). In surgical cases, clinical outcome at discharge showed good recovery (GR) in 14 cases, moderate deficits (MD) in 11 cases, severe deficits (SD) in 2 cases, and dead (D) in 4 cases. In embolization cases, clinical outcome at discharge showed GR in 19 cases, MD in 4 cases, SD in 1 case, and D in 1 case. Embolization with detachable coils is less invasive than surgical clipping in the management of patients with posterior circulation aneurysms. Embolization with detachable coils in ruptured posterior circulation aneurysm cases at an early stage of SAH may improve clinical outcome.