The authors present two patients with subarachnoid hemorrhage caused by ruptured intracranial saccular aneurysms of the persistent primitive hypoglossal artery. A standard unilateral suboccipital approach in one patient resulted in incomplete neck clipping since the operative field was restricted by a protruding jugular tubercle. Successful aneurysmal neck clipping was achieved in the second patient via a unilateral-transcondylar-suboccipital approach with resection of the jugular tubercle and rim of the foramen magnum.