Major improvements have been achieved in endovascular treatment of cerebral aneurysms during the last twenty years. Initial techniques of selective balloon occlusion were progressively replaced by controlled packing of the aneurysmal sac with soft detachable platinum-coils (GDC). In some patients with large or giant aneurysms of the cavernous portion of the internal carotid artery endovascular parent vessel occlusion therapy with balloons is still necessary. In aneurysms of the proximal paraclinoidal segment of the internal carotid artery a combined endovascular and microneurosurgical approach, the "evacuation-trapping"-technique might be helpful. In patients with symptomatic cerebral vasospasm in whom conservative therapy has failed or is not possible balloon angioplasty and or the intra-arterial infusion of papaverine has become a valuable therapeutic alternative. Further follow-up studies are necessary to assess the value and long-term results of endovascular strategies.