The management of of unruptured intracranial aneurysms is one of the most important issues confronting neurosurgeons today. The high mortality and morbidity associated with subarachnoid hemorrhage (SAH) has prompted interest in repair of aneurysms that are discovered before they have ruptured. A strong risk factor for intracranial aneurysm which causes SAH is a positive family history, polycystic kidney disease and patients who have survived a SAH. There is no cutoff size of aneurysm below which rupture is not possible. Presently there are no definitive guidelines in the management of incidental aneurysms and many centers consider each case individually with treatment offered for lesions more than 7 mm in diameter especially if patient is relatively young without major co-morbidities. Even though microsurgery offers the advantage of proven durability and higher rates of total aneurysm obliteration, the choice of treatment modality between open microsurgery and endovascular occlusion is flexibly adjusted to each case.