Aneurysms arising from the segment of the internal carotid artery (ICA) between the proximal dural ring and the origin of the posterior communicating artery (PCoA) constitute paraclinoid aneurysms. Nutik coined the term "paraclinoid aneurysm" to describe aneurysms arising from the ICA opposite the origin of the ophthalmic artery. Paraclinoid aneurysms are mainly intradural and therefore are associated with a potential risk of subarachnoid hemorrhage (SAH). They are frequently large or giant and have a common close relationship with the bone of the skull base and with the dural folds around the ICA. Because of the complex anatomical relationship among neurovascular, dural, and bony structures, management of paraclinoid aneurysms is more challenging compared with intracranial aneurysms at other locations. Advances in surgical techniques and cranial base approaches have resulted in significantly improved surgical outcomes for paraclinoid aneurysms. In addition, endovascular procedures have become the second choice management modality