Fenestration of cerebral vessels is congenital and usually of no clinical significance. A 58-year-old female presented with left trigeminal neuralgia associated with double fenestrations of the vertebrobasilar artery. Vertebral angiography showed bilateral fenestrations in the intracranial segment. The left fenestrated artery originated at the distal portion of the vertebral artery and terminated at the middle portion of the basilar artery, compressing the left Vth cranial nerve root. The neuralgia improved after microvascular decompression. Fenestration of cerebral vessels is usually single. Five of eight reported cases with double fenestrations had bilateral extracranial fenestrations at the atlantoaxial portion of the vertebral artery. Bilateral fenestrations of the vertebrobasilar artery with trigeminal neuralgia have not been previously reported.