The 15-nation council reached a dead end with most members standing against Russia and China, Syria's two allies, which abstained on Saturday, the council's fifth vote on the issue this week.
Russia and China expressed their desire to reduce the number of crossings to one crossing, and said that humanitarian aid could reach northwestern Syria from within the country.
The two countries have also sought to include phrases that Western diplomats say hold Western sanctions on Syria responsible for the humanitarian crisis.
The Council was also divided over the extension of the mandate for six months or a year, and the decision, which was prepared by Germany and Belgium and approved at the end of the day on Saturday, authorized the use of one crossing for one year.
"Russia has always supported the introduction of humanitarian aid to Syria with full respect for the country's sovereignty and territorial integrity and in coordination with its legitimate government, this issue should not be politicized," said Dimitri Polianski, deputy UN envoy to the United Nations after the vote.
Twelve countries voted in favor of the draft resolution, and the Dominican Republic abstained, as well, and the successful vote came after two failed vote attempts on Russian proposals and two other votes by Germany and Belgium and Russia and China vetoed them.
Germany and Belgium said in a joint statement after the vote: "One border crossing is not enough, but the lack of any crossing point will raise concern about the fate of the entire region."