Management of unruptured intracranial Aneurysms Abstract. Unruptured intracranial aneurysms (UIAs) are a common coincidental finding in cranial imaging of patients with non-correlated symptoms such as headache or dizziness. With an estimated prevalence of around 1 - 2 % in the general population, these UIAs often present clinicians with difficult decisions. This is particularly the case since, despite extensive research in this area, the natural course of UIAs is still poorly understood and the risk of rupture cannot be specified. Due to often catastrophically clinical outcomes as a result of an aneurysmal subarachnoid haemorrhage (mortality-rates of up to 51 %), the desire for intervention and the emotional burden on the patient in the case of diagnosis of an UIA is often very high. For this reason, the knowledge of average rupture rates, factors that influence them, but also knowledge of the complication rates and the result of interventions is essential for the clinician in order to arrive together with the patient at a responsible and reasonable decision regarding the treatment of an UIA. In this review, we present the current state of science regarding the natural course of UIAs, the possibilities of intervention and strategies in patient management based on current guidelines.