We describe the first reported use of simultaneous bilateral vertebral artery rotational angiography to visualize an aneurysm. Images acquired from 3D rotational angiography with a single vertebral injection provided insufficient anatomic detail in two cases with vertebrobasilar junction aneurysms associated with fenestration. Therefore, simultaneous bilateral vertebral artery 3D rotational runs were performed. Anatomic detail was superior with the simultaneous injection and this allowed for the appropriate plan of care to be instituted. In the rare cases of vertebrobasilar junction aneurysm associated with fenestration, simultaneous bilateral vertebral artery 3D rotational angiography may provide the most useful anatomic detail when evaluating a patient for possible endovascular intervention.