Intracranial aneurysms have been known for centuries. In the 19th century many excellent contributions were made toward the awareness and increased understanding of the nature of these treacherous lesions. It was not until the 1950s that a few pioneers started direct attacks with attempts to occlude ruptured intracranial aneurysms. From early surgery the pendulum swung to delaying surgery because of the many disastrous events associated with attempts to approach the circle of Willis in the face of a red, swollen, and angry brain. Such delayed surgery unfortunately had only a moderately beneficial effect on the overall outcome. With the introduction of the counterbalanced operating microscope, the wide range of microsurgical instruments, improved neuroanesthesia, and major advancements in diagnostic neuroradiology, the pendulum has swung back to early surgery (preferably within 48 h) for anterior as well as posterior circulation aneurysms in specially geared referral centers with accumulated experience and organization to handle such extremely demanding emergency procedures. Nevertheless, even today, <60% of all individuals who are struck down by the rupture of an intracranial rysm and are alive on admission to a neurosurgical center with a liberal policy of immediate admission irrespective of grade can be expected to show a favorable outcome. The evolution of intracranial aneurysm surgery and the historical landmarks leading to our present knowledge of this readed disease are depicted chronologically.