Introduction and objective: Unruptured intracranial small aneurysms (uSIA) are increasingly detected, yet data on early quality of life (QoL) outcomes after prophylactic treatment remain limited. This single-centre pilot study aimed to characterise a highly comorbid cohort undergoing treatment for uSIA and to assess short-term QoL changes. Materials and methods: Thirty-two adults with uSIA (saccular aneurysms ≤7 mm) scheduled for elective neurosurgical or endovascular treatment in 2024–2025 were prospectively enrolled. Demographic data, vascular risk factors, comorbidities, aneurysm characteristics, treatment modality, and peri-procedural events were collected. QoL was assessed with the EuroQoL EQ-5D-3L questionnaire, including EQ VAS, at admission and one month after intervention. Results: The mean age was 57.97 years and 65.6% were women. Comorbidities were frequent, including hypertension (65.6%), hypercholesterolaemia (43.8%), and diabetes mellitus (28.1%); 62.5% had a history of smoking. Microsurgical clipping was performed in 12 and endovascular treatment in 19 patients; stents were used in 16 procedures. Overall, 31 patients had at least one uSIA treated (mean 1.22 aneurysms per patient). The mean EQ VAS score increased from 70.47 at baseline to 76.13 at one month, a mean change of +5.32 points (SD 10.95; p = 0.016). The proportion reporting any anxiety/depression decreased from 46.9% to 34.4%. Conclusions: In this highly comorbid cohort, prophylactic treatment of uSIA was associated with no short-term deterioration and a modest overall improvement in QoL, alongside reduced self-reported anxiety. These preliminary findings are pilot in nature and warrant confirmation in larger multicentre studies with longer follow-up.