Basilar artery trunk aneurysms (BTAs) are relatively rare, with poor natural prognosis, high disability and mortality rates. The treatment options for BTAs includes conservative treatment, craniotomy, and endovascular treatment. Due to the deep anatomical structure, rich perforating vessels, and complex pathological structure of the basilar artery, craniotomy is more difficult. There is currently no consensus on the treatment of BTAs. This article reviews the current treatment status of BTAs, aiming to provide reference for clinical work.