Intraoperative aneurysmal rupture (IAR) is one of the most dramatic complications of intracranial intervention. Its frequency, depending on the aneurysm’s localization and anatomical features, may reach 50%. IAR leads to the increase of unfavorable outcomes by 1.5–3 times. There exists a variety of techniques aimed to reduce the frequency of this complication, however, all of them have essential limitations. The review presents analyses of the basic risk factors for IAR and techniques of its prevention, as well as modern approaches directed at the alleviation of this complication’s consequences.