Giant intradural aneurysms are associated with an extremely grave natural history, yet remain potentially curable. Those aneurysms located on the intracavernous segment of the internal carotid artery are associated with a more benign natural history but frequently present with intractable cranial neuropathy requiring intervention. Proper current management requires a multidisciplinary approach through which the therapeutic goals are clearly defined. The treatment of giant intracranial aneurysms must be individualized after considering the various therapeutic options available to the multidisciplinary team. The cost of managing these complex lesions can be reduced by minimizing complications. Future advances in our ability to better manage patients with giant intracranial aneurysms will require careful assessment of outcome parameters.