The management of intracranial aneurysms remains a challenge in 2022 and for coming years. As the amount of available data expands in biomedical warehouses, the development of statistical and informatics tools applied on real-life medical records may help to address this challenge. Here, we propose how the use of such data, alongside data collected from randomized controlled trials, can help in patient management. Through the widespread use and improvement of neurovascular imaging, unruptured intracranial aneurysms (UIAs) are incidentally found in “healthy” individuals; their management remains a challenge for physicians and patients alike. Here, we discuss the challenges facing observational study (OS) design in the field of UIAs and propose to better leverage the biomedical data warehouse.