Over recent years, an increasing number of patients with intracranial aneurysms are treated by endovascular techniques, which have the advantage of avoiding craniotomy and retraction of cerebral parenchyma, while reducing the postoperative hospital stay. The key concept is that aneurysm is a disease of the arterial wall and that treatment must ideally only concern the vessel. The short-term efficacy of endovascular treatment has been established, especially for the prevention of early rebleeding, but its long-term efficacy has not yet been formally demonstrated due insufficient follow-up. Ideally, the management of intracranial aneurysms should be based on close collaboration between neurosurgeons and interventional neuroradiologists and the approach (conventional surgery or endovascular) should be discussed case by case.