**Abstract**

Treatment strategies for cerebral aneurysms have changed dramatically in recent years with advances in endovascular therapy. Advances in devices, endovascular surgeons' skills, and diagnostic modalities have improved the results of endovascular treatment, making it a safer and more reliable treatment option. On the other hand, we are encountering an increasing number of cases of postoperative recurrence. Direct surgery has a specific role in treating these recurrent cases, and it has become essential to establish a decision-making method and surgical technique for treating these cases. In this chapter, I will discuss the treatment options for recurrent cerebral aneurysms after endovascular treatment and the practical application of direct clipping and bypass surgery.

**Keywords:** cerebral aneurysms, direct surgery, endovascular treatment, recurrence, neurosurgery
