Abstract: Objective To study the strategy for anterior communicating aneurysm(ACOA), and its therapeutic effect and prognosis. Methods Clinical data about 94 ACOA patients admitted to our department from January 2010to August 2012 were retrospectively analyzed. Results Of the 94 ACOA, 89 were directly clipped, 2 were incised and clipped, 1 was proximally isolated combined with distal bypass, 2 received no treatment. The Glasgow outcome scale (GOS) score was 5, 4, 3 and 2, respectively, for 80 (85.11%), 8 (8.51%), 2 (2.13%), and 4 (4.25%) of the 94 patients. Eighty patients were followed up for 3-36 months, during which the GOS score was 5, 4, 3, and 1,respectively, for 71 (88.75%), 5 (6.25%), 2 (0.25%), 2 (0.25%). Conclusion Microscopy-guided clipping is a safe and effective procedure for ACOA.