Management strategies for giant intracranial aneurysms are presented. Safe treatment of these lesions requires a complete diagnostic evaluation preoperatively, selection of the optimal surgical approach, early vascular control of the aneurysm, and careful clipping technique. Important intraoperative adjuncts, such as skull-base surgical approaches, endovascular methods, and hypothermic circulatory arrest greatly facilitate the treatment of these lesions. Some giant aneurysms cannot be clipped directly and require alternative techniques, such as proximal parent artery occlusion, excision, or aneurysmorrhaphy. Bypass techniques are an important aspect of these alternative treatments. Giant aneurysms are the vascular neurosurgeon's greatest challenge, and well-designed surgical strategies are critical to their successful treatment.