This study was conducted on Thirty Seven patients with Intracranial Internal Carotid artery (ICA) aneurysms. All cases were subjected to full clinical examination, laboratory, and neuroradiological studies. The decision was taken for the appropriate approach of surgical management. These include the standard fronto temporal microsurgical Trans-sylvian approach, Dolenc approach and endovascular technique using balloon or coil when indicated. From the results of this study as well as other studies of ICA aneurysms and its branches, the following could be concluded: 1) The commonest site is the posterior communicating artery aneurysm followed by ICA and its bifurcation. 2) The most common configuration encountered is the saccular type.3) The most common presentation is headache with SAH due to rupture of the aneurysm. Syndromes of unruptured cerebral aneurysms are highly diverse, and relate to location of the aneurysm, adjacent neural structures, and the vascular territory of parent vessel. 4) Four-vessel cerebral angiography remains the most important diagnostic tool prior to any surgical intervention. An Intraoperative IADSA achieves many of the same goals as a post operative angiogram, and allows adjustment of the aneurysm clip to obliterate the entire neck of the aneurysm at the time of the initial surgery. CT scan remains a very sensitive tool to diagnose subarachnoid and/or parenchymal clot, vasospasm, cerebral edema, infarction, or hydrocephalus. MRI of giant aneurysms is complimentary to CT.5) The imaging evaluation of aneurysms include demonstration of number, location, size and morphologic appearance, as well as the location of the neck in the case of saccular aneurysm. 6) Early surgery and Nimodopine treatment appears to accelerate clearance of blood from the subarahnoid spaces and reduce the incidence of delayed ischemic neurological deficits in good risk patients; "clinical grade I, II, and III". In addition, early aneurysm repair would safely permit induced hypertension, hypervolemia which could reverse incipient ischemic neurologic deficit (IND).7) Serial monitoring of vasospasm is now possible at the bedside using transcranial Doppler (TCD). Intracisternal fibrolysis and other pharmacologic manipulation are being intensely studied and may further dramatically affect management and outcome of cerebral vasospasm. 8) In this study, the incidence of shunt dependent hydrocephalus as a sequel of SAH was reduced compared with other reports. 9) Microsurgical frontotemporal trans-sylvian approach was performed in the majority of cases, Dolenc approach in two cases of intracavernous aneurysms and Endovascular technique in the remaining two well selected cases. 10) Endovascular techniques have evolved rapidly in the last decade. For inoperable cases, primary aneurysm treatment with balloons and coils is now routinely attempted and is frequently successful . Other endovascular techniques are on the horizon, including stents, glues, and safer and more effective coils. Finally in spite of all efforts using modern tools in the diagnosis and management of intracranial aneurysm and SAH we are still lacking decisive information:a) When the aneurysm will rupture?b) Mechanism, prevention and management of pre- and post-operative spasm in spite of the significant progress which has been made in the areas of detection, prevention and management of vasospasm.c) Rebleeding and the ideal way of preventing it.d) Timing of surgery with its large debate and,e) The proper choice whether the standard direct microsurgical approach or the upcoming endovascular technique.