Cerebral revascularization offers an important adjunct to parent-vessel ligation in the treatment of large and otherwise inaccessible intracranial aneurysms. Good or excellent outcomes can be expected in approximately 80% of patients. Poor outcomes and ischemic complications were highest in posterior circulation lesions. Cranial neuropathies from mass effect associated with giant aneurysms of the cavernous and intradural internal carotid artery will improve and be cured in the majority of patients treated with universal revascularization approach. In combination with open parent vessel ligation or endovascular occlusion, durable protection from subarachnoid hemorrhage can be achieved.