Fusiform aneurysms represent a small subset of intracranial aneurysms that form from the pathological circumferential dilatation of a length of cerebral artery. These lesions have separate inflow and outflow sites and frequently differ from saccular aneurysms in both their clinical presentations and surgical treatment. Thromboembolic complications and hemorrhage occur from these aneurysms. This article reviews the pathophysiology and clinical presentation of fusiform aneurysms and also discusses some of the special considerations regarding surgical treatment of these lesions.