| Summary: | Background: Once the decision is made to treat the intracranial aneurysm, we should consider between two competing treatment options; open surgery or endovascular therapy. The rationale underlying the choice of treatment modality is usually unclear, as there is little good quality evidence available. Methods: We discuss here the patient, risk factors and the aneurysm related factors for decision making in management of intracranial aneurysm between endovascular and microsurgical modalities of management. Results: The relevance of age of patient, modifiable and nonmodifiable risk actors, family history, rupture status of aneurysm, aneurysm related factors like morphology of aneurysm and multiplicity are discussed here. Perceived differences in efficacy and safety of the two different treatment approaches are commonly used in an attempt to justify treatment choices. Difficulties with treatment selection and case to case management plan should be considered. Conclusion: Properly designed and randomized controlled trials need to be done to address these issues for choosing best management to the patient and definitive guidelines must be made to solve this confusion. Keywords: Intracranial aneurysm, Endovascular coiling, Neurosurgical clipping, Unruptured intracranial aneurysms, Ruptured intracranial aneurysm, Subarachnoid hemorrhage, ISAT
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