This review aims at summarising, whether unruptured intracranial aneurysms (UIAs) should be managed by immediate closure or surveillance imaging. If small UIAs should receive immediate closure might be up for a paradigm shift. The most fatal consequence of a UIA is rupture, as it carries a high mortality and morbidity. Several studies have identified size as the strongest predictor of rupture, as rupture risk increases with aneurysm size. Also, growing aneurysms are more prone to rupture, and therefore growth and size must be the main assessment points, when deciding if the aneurysm should receive immediate closure.