Abstract: Objective To study the application of intraoperative CT in intracranial aneurysm surgery. Methods Twenty intracranial aneurysm patients who underwent craniotomy in our hospital from March to July 2012 were included in this study. Surgical procedure was decided according to the twice CT perfusion (PCT) and CT angiography (CTA) findings before and after clipping of aneurysm and compared with conventional intraoperative monitoring methods such as somatosensory evoked potential (SSEP), microvascular Doppler ultrasonography (MDU). Results Twenty-three aneurysms were successfully removed. The outcome was good in 19 patients (95%) and poor in 1 patient (5%) according to the GOS criteria. The quality of images including 41 PCT and 20 CTA images was good in 57 patients(93.4%) and poor in 4 patients(6.6%). Intraoperative CT showed abnormal brain perfusion in 1 patient, which became normal after the clip was replaced. CTA showed no residual aneurysm and parental artery occlusion.SSEP was significantly abnormal in 2 patients and MDU was abnormal in 3 patients. CT scan after operation revealed no cerebral hemorrhage and satisfactory hematoma evacuation in 2 patients. Conclusion Intraoperative CT is an important means for the assessment of residual aneurysm, stenosis or occlusion of parental and perforating arteries in clipping of intracranial aneurysm.