The concept of using balloons to treat cerebrovascular lesions was inspired by a 1959 May Day celebration in Moscow’s Red Square. While watching children easily maneuver helium balloons using tether lines, Serbinenko, began to envision small balloons moving through tortuous arteries. In 1970, Serbinenko shook the endovascular neurosurgery field when he performed the first therapeutic vessel occlusion using a detachable balloon catheter for intracranial aneurysm embolization. In 1974, Serbinenko disrupted the field again when he described the first endovascular treatment of over 300 patients using detachable and non-detachable balloons, confirming the feasibility of balloon occlusion of cerebral arteries and aneurysms. The basic concepts pioneered by Serbinenko 60 years ago for the treatment of occluded cerebral vessels remain viable today. In recent years, applications of balloon embolism have expanded to include performing intracranial and cervical angioplasty for atherosclerotic disease and treating arteriovenous malformations, among others. However, there is still more to be done.