Clinical application of neuro-endovascular therapy was first reported in 1974 by Servineko et al., who used a detachable balloon to treat a symptomatic carotid cavernous fistula. The fistula was occluded by the detachable balloon and the patient′s symptoms improved. Embolization of aneurysms was greatly advanced by the introduction of the Guglielmi detachable coil, and since then, remarkable progress has been achieved in endovascular treatment of aneurysms. Verification of the efficacy of neuro-endovascular therapy for ruptured aneurysms, such as coil embolization for intracranial aneurysms, has been demonstrated by the International Subarachnoid Aneurysm Trial (ISAT). ISAT results indicate the vital role played by this therapy in improving the treatment of subarachnoid hemorrhage. Recently, new instruments for neuro-endovascular therapy have been approved for clinical use in Japan. These instruments include vascular reconstruction devices (VRD) such as the Enterprise self-expanding stent system for unruptured wide-neck aneurysms larger than 7 mm, Onyx (ethylene vinyl alcohol) liquid material for embolization of arteriovenous malformations, and the Merci retriever for mechanical removal of emboli in acute stroke within 8 hours of onset. Furthermore, innovative diagnostic modalities, such as flat panel detectors and three-dimensional digital subtraction angiography (3D-DSA) have contributed to both the development and safety of neuro-endovascular therapy. Advances in device and diagnostic technology have made it possible to treat even difficult cases. This review summarizes current neuro-endovascular treatment for neurosurgical diseases.