Intracranial arterial aneurysms are an important cause of hemorrhagic stroke during the first two decades of life. In the pediatric population, intracranial arterial aneurysms have a diverse etiological spectrum. The clinical course, response to treatment and long-term prognosis correlate strongly with the mechanism of lesion pathogenesis. A variety of phenotypes have been characterized, having variably overlapping features and differentiated according to the mechanism of pathogenesis: (1) idiopathic, (2) traumatic, (3) infectious, (4) flow related, (5) oncotic, (6) non-infectious inflammatory, (7) arteriopathic and (8) familial. The purpose of this report is to review intracranial aneurysmal disease in the pediatric population. We discuss contemporary approaches to diagnostic evaluation and clinical management, emphasizing interventional strategies and recent advances.