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Rupture of an intracranial aneurysm is a life-threatening event. Only one third of intracranial aneurysms rupture during a patient’s lifetime. Accurate markers that predict which intracranial aneurysms rupture and which do not are currently lacking in routine clinical practice. Therefore, the treatment decision is a careful balance between the natural history of the intracranial aneurysm and the risk of intervention based on aneurysm- and patient-specific risk factors. Many of these risk factors are also used to determine the modality of intervention. In this review, the authors discuss the interdisciplinary decision-making process and treatment approach in the era of complementary techniques for intracranial aneurysm obliteration.