The surgical management of eight patients with infective endocarditis and intracerebral mycotic aneurysm is presented. Three patients had craniotomy before valve replacement and four patients had valve replacement before craniotomy. There were no deaths related to the valve replacement or craniotomy. Two of the eight patients died in the hospital of continuing sepsis resulting from undrained foci of infection. It is concluded that the drug-addicted patient with a mycotic aneurysm and hemodynamic decompensation from endocarditis can be successfully treated by staging the operations according to the more severe problem.