Vascular Neurosurgery is an exciting yet complex field. Surgeons are able to enter into the human brain and dissect out blood vessels that supply important functions. However putting too much distortion on blood vessels causes them to go into spasm which may cause a stroke. Pathology in vascular neurosurgery, as in any field of neurosurgery, is extremely diverse. Diseases range from unruptured intracranial aneurysms to massive hemorrhagic arteriovenous malformations to congenital vascular anomalies. But dangers lurk at every corner. We put together this textbook of vascular neurosurgical vignettes to help teach students and residents in all fields about a variety of clinical scenarios that they may be presented with in the emergency room, intensive care unit, or in the operating room. This text utilizes over 7 years of vascular clinical vignettes and displays the neurointerventional aspects of neurosurgery as well which has become more popular over the last few decades.